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pate � I� �O Pu�litlYo2sPatm�t� / O ^ /"� � <br /> Application For Biaq.oem • <br /> PUBLIC WORKS PERMIT PublicWo�kaFee <br /> Total Fee � <br /> Less Aoo�Fee Pa�e g <br /> Balanco D�c S ���� <br /> Print or Type Only <br /> David A •*Jean M, lay�or 538 �. Mc,rineView Dr. Everelt�WA 982p1 <br /> Owner M ilingAddress City 2ip Phone 259-1591 <br /> Sarne <br /> Applicanl Mailing Address City Zip Phone <br /> Desr�ibeProposedWork � Y1S�U�� Cl ��� Cl(1d 70� �fl\/PV�/QV OTf _E. Murine. <br /> V12W �rl�lPi <br /> Project Address(if known) 5510 E . Ma�ine v;ew Dr�. � eretf Wq q8201 W <br /> � <br /> Attach lour(4)copies ol plans for proposed woik- Draw to scale and note Ihe following as applicable: � <br /> • Property Lines • Centedine ol streel � <br /> � Outline and dimensions of all r,xisting and • Indicate North <br /> proposed strudures on the lot • Show any proposed gradin9 changes <br /> • Existing and proposed utilities • Show measurements � <br /> DO NOT WRITE BELOW THIS LINE O <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 pedormed in accordance with thi&permit�nd wrrent City of Everetl Design and Construction <br /> Standards and Specilications. <br /> 3.Call Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1-800•424•5555. � <br /> � C�ui-u.i�uJ ��,uf' BZ-2Y0 /I.�.L'� llfr�cHfo SKi-rcH, O <br /> �/ <br /> 04/17/90 8�3:RM OOORkiD53 �f <br /> / � <br /> H00�32895 O <br /> DRVW'� 820.Q0 <br /> CHECf; 420.00 � <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereUy agrees to hold and save harm� <br /> less the Cily of [verett Irom any and all claims lor damages, costs, <br /> expenses, or causes of action that may arise hecause of installation <br /> ` i/ /7/`1� and maintenance ol ihe improvement or othe� right�obway use hereto <br /> � �� � — applied for and lurther agrees to remove same upon notice irom the <br /> Approved for�nslr on Date City and to replace public property damaged Ihereby. <br /> C c� �ll��__3'/d �� � . �1 <br /> FINAL INSPECTION Date ii /N .� `"1 I C <br /> Approved as Constructed ic�nature ot A� plicant Date <br /> everett PUBLICWORKSDEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> � 3200CedarStreet 180 DAYS OF DATE P[RMIT IS ISSUED AND THEREAFTER IS TO <br /> Everett,WA 982p1 BE UIIIGENTLY PURSUED TO COMPL[TION. THIS PEIiM1T MAY B[ <br /> Phone:259�88t0 CANCELLED BV THE CITY UPON ANY STOPF�GE OF WORK ON THIS <br /> PROJECT OVER 90 DAYS DURATION. <br />