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— Q �5���4 <br />Date�25-3� <br />Applica�ion For , <br />PUBLIC WORKS PERMIT <br />r� <br />- r:� o r_� i'� �_ � �-� <br />JUN � 61996 �:� . „�.—� ,,, -,, . <br />Print or Type Onry �r��TING ' `" ° "�' ' `' -` <br />�� �•. _.� a, ... ;.� �..�, r• <br />� ,r <br />� �h _ 1 b: lf tP . <br />n: n .r. _� <br />Clark Cooke 1 <br />Oomer <br />qpplicanl <br />bia�tinr; 4r:dress � � �.��Y <br />�. ��rnrc'� <br />;\ nno�U <br />N 3t. � �i. v: <br />O <br />r,_��G�,a �dd�ess � cav <br />Describe Proposed Work new_ house _,___—_-- <br />Pue��c\vo�tsnr�ma. _.r! / �/{/ (—/ <br />D�nq Uunt . _4�j-� _—. <br />�,�,,,,�,vo,�sF�� --- <br />iaiN Fee 5 — <br />�Css ApDI Fce Pa�.:f S�/�--�— <br />O C: f'�.��nn,��f�ur $ W <br />�_, ,_ � <br />�� r' . <br />, r: <br />n+ �O U <br />�'� <br />iF u' <br />ri�: =z c � N, rr��-u, .. <br />� L j O W C'� �_� <br />i U".`03 U'J .. <br />i o- - i o i-. <br />;mrin. xer�i5in c' <br />Zip <br />. . _.._----- <br />-- ------ <br />�j _--�/-- -�. �-/-) - I--- ----- <br />Project Address lif knou�n! �) I_� �—�V'`-f-'��"�--✓-`��------- <br />Attach four 14) coPies of Plans fo� Pronosed wor.. - U�ar: t, ,,:,d., .u,,i ncte m.a'oiluwmg as aoUhcabie <br />• PrOperty Lines • CHnloriine ol street <br />• Outline and dimensions ol all exishng ind • Intlicale Norlh <br />proposed slructures on Ihe lo� • Show any CropoSCd Jrahrt�4 r.h:inge5 <br />� Eaisting and proposed utiGties • Shrnv measurements <br />ri,�,�,e <br />Phnn� <br />PERMIT CONDITIONS <br />1. All calls for inspection shall be made 24 hrs. in advance • phone 259•8810. <br />2. All work shall be performed in accordance with this permit and current City of Everett Design and Construction <br />Standards and Specifications. <br />3. Call Location Underground Service 48 P�rs. before you dig. TOLL FREE NUMBER 1•S00•424-5555. <br />ApProved as Consiructed <br />���IP� PUBLIC WORKS DEPARTMENT <br />3200 Cedar Slreet <br />Everett. WA 98201 <br />Phone:259-BB10 <br />i <br />W <br />� <br />� <br />� <br />� <br />O <br />� <br />� <br />O <br />a <br />ACKNOWLEDGEMENT OF CONDITIONS <br />1ha unA�araianed o�vne�!aPPlicant herftly ac7reC5 to h01d antl sace. harm� <br />less the Cny ol Everett from any antl all claims tor tlama9es, costs. <br />e.penses. or causes ol action that may arise because ol installation <br />and maintenance M the improvemenl or o�her right-ol-way uso he�eto <br />i; phed for anA lurthe� a9iees to remove samc apon notice Irom ihe <br />C�.!�1::d Io rePlxe C�1��I�C property damaged thereby. <br />( ( �'� s-r9-9s <br />Si n. Iwe of ApPlican' ���Q <br />N'ORK AUTHORIZE BY t'iil5 PERMIT MUST BE STARTED WITHIN <br />190 DAYS OF DAT P NIT IS ISSUED AND TH[REAFTER IS TC1 <br />8E DILIGENT�1' PU GD TO COMPLETION. THIS PERMIT WAY B[ <br />G4NCELLED BY THE CITY UPON ANV STOPPAGE OF WORK ON THIS <br />FRO.iECT OVER 90 DAVS DURATION. <br />