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y N <br />tt m <br />ta <br />H <br />CN <br />y <br />M i� <br />� H b <br />O W O <br />� y N <br />� H � <br />N <br />" "RG1 • <br />H <br />�,' M <br />� r� y <br />N <br />M <br />O tn <br />�StE�.�sr <br />H O N <br />' � <br />� �'► s� <br />Date�J�3,[92 <br />Application For <br />PUBLIC WORKS FERMIT <br />Print or Type Only <br />> 'i cuoe� wmxa v��mn • <br />nme o�o� , �7A76 <br />GubLc Work! Fep <br />ToleiFce 5 <br />less RppL Frte Pa�J S <br />PainnceJuc 5 <br />Dfarcia Thompson 2001 blcdouqal Everett 98201 <br />Owner Mailing Address City Zip Phone <br />Viking Const. PO Box 7340 Everett 98201 259-7250 <br />Applicant Mailing Address Ci�y Zip Phone <br />Des�-�ibe Proposed Wurk 6]^�*r„rt nnyi�a�'�a 1hv94cf <br />Proiect Address (il known) 2001 Mcdougal <br />Attach lour (4) copies ot plans for proposed work - Oraw to scale and �ote the tollowing as apP�icable: <br />• Pwperry Lines • Centerline ol street <br />• Outline and dimensions ol all exisiing and • Indicaie North <br />proposed slructures on ihe lot • Show any proposed 9mAiny chan9es <br />• Existing and p�oposetl u�ilities • Show measurements <br />PERMITCONDITIONS <br />1. All calls lor inspection shall be made 24 hrs. in advance - phone 259•8810. <br />2. All work shall be pedormed in acwrdance with this permit . nd current City of Everetl Des�9n and ConsVuction <br />Standards and Specifications. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1•800•424•5555. <br />��' /( �/'�it' �i;��-i�/,' �)('.: i,:i f ,�i��/i.;i;( ..�1-' <br />l� <br />' ✓ <br />-' �..: _ ..;�.. <br />�) �'�� ..,� T <br />�%� /1'%!Cl�.� .flJ .� � �DIL✓2[ c'Cc:�cr � .; �";�i . -- `,,� ', <br />�.-� y" �� �, .s. �� ,_r, �4 �,��` �>�� i��;. „ <br />ApproveA lor i�onstruct�on <br />i� <br />O <br />� <br />Y / <br />0 <br />a <br />ACKNOWLGDGEM[NT OP CONGITIONS <br />7he undereigned owner/applicant hereby agrees to hold and save h,unr <br />— less Ihe City ol [ve�M� Irom any and all claims lor dama9es. costs. <br />expenses, or causes ot aclion that may arise because of instrdlation <br />and maiMenance ol ihe iniprovement or other n�ht�ol-�vay use hereto <br />applied lor and lurther agrees to remove same up�n nolice Irom Ih�� <br />Date City and to replace puUhc property dama9ed thereby. <br />FINAL INSP[CTION ���� <br />Approved as Constructed <br />�PUBLIC WORKS DEPAR7MENT <br />� 3200CetlarSireet <br />E�,nrelt WA 98201 <br />Phone 259�8810 <br />Signature ol Applicant ���" <br />WORK AUTHORIZCD BY TIiIS PERMIT MUST BE STARTED WITIiIN <br />100 DAYS OF DAT[ PERMITIS ISSUED AND THEREAFTER IS 1� <br />BE DILIGENTl.1' PURSUED TO COAIPLETION. THIS PERMIT MAY HI. <br />CANC[LLED BY THE CITV UPON ANY STOPPAGE OF WORK ON Pi�`� <br />PROJECT OVER 90 DAVS DUNi1TION. <br />