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�!/ - 'i - _ � - S � � •-- <br />Date 5-1�-9,y <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />Anibni 6 Patricia VurRns 3527 Hockefeller Ave Ev�rett 98201 <br />Owner Mading ACdress City ZiP <br />`ticl�nel r:alov 652-5601 <br />Applieant Mailing Address City ZiP <br />oescribe Pronosed work chn�i.�e of uee f.rom SFR to <br />Prol�cl Address id knownl <br />1527 RockefPl] <br />PUUbc\'/orkSPr.�mi�• S ��/ _ <br />Bciq ocnt. � 4R 7 a6 <br />N�II�I¢ Y10145 FOO p <br />lO�i11 FCC J <br />LM' �OOI Fne Panf S <br />pO <br />�aqnce Oun 5 v �� <br />Phone <br />Phone <br />Attach four 14) copies ol plans tui pioposed wurk � �rav: to ��:ab.� ,rid note the 1o11oiving as anPlicabie. <br />• Property Lines • Centerline ol street <br />• Outline and Aimensions of all exi,hng anA • Ind�cat�� Norih <br />proposetl structures on Ihe lot • Show any {:roposeA �rad 9 cpaqges <br />• Existing and proposed utilities • Show measwements �,�' -'' �°' ��Sj�ia i_�UI?i11:'��.�_ <br />:1�[�PfICIt.Y� <br />C�Ct: ?.ji�.LH1 <br />PERM�TCONDITIONS HE':N +�O.Di; <br />1. All calls tor inspection shall be made 24 hrs. in �dvance - phone 259-8810. . � � <br />2. All work shall be pedormed in acr.ordance with ihis permit antl current City ol Everett Design a��;Eonslru�Bd�n�'� <br />StandardsandSpecifications. Df':l'aY �i..l.''�0 <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-B00•A24fS555.i ?;; .�.0 <br />CtiECl; .'���.SL� <br />� /[�/,.C��I�;. L}.1.(� .�?'r,.., ��?` �i,� yi.r (�;� �Jr -�q<...l;�.,l'. <br />/ C� \ � i. <br />( (/ � / <br />��;L�.. !/ . ..J/ <br />i i ,� <br />�__: ,{.,.�,��p-•./r. <br />Approved lor Consiruclion ���� <br />I FINAL INSPECTION <br />Approved as Constructed <br />��rL�� PUBLIC WORKS DEPARTMENT <br />3200 Cedar Street <br />Everett, WA 98201 <br />Phone:259�8810 <br />L___ __—__ _ _ __ <br />Datc <br />� <br />O <br />'�w <br />_ I <br />O <br />a <br />ACKNOWLEDGEMENT OF CONDiTIONS <br />The undersiqned ownedapplicant hureby agrees to hoid and save harm� <br />less Ih� Gry of Everei� from any and all claims for dama es. costs. <br />expenses. or c�uses of action that may ans� because ol nstallalion <br />and maintenanr.e ol lhe imp�ovement or other nght�obway �se hereto <br />apphed for and further agrees �o remove same upon nctice Irom the <br />Ci;y and lo replace puUlic propertY damaged iheieUy. <br />„j�'- ���:�(- �� �,._ j. <br />' Sinnalwe ol APPlicant Pale <br />INORK AUTHORIZEO BV TIiIS PERMIT MUST BE STARTE � WITHI� <br />180 DAYS OF DATE PERMIT I,i ISSUED AND THEIaEAF15R IS TO <br />�E DILIGENTLY PURSUED TO COMPLETION. TNIS PERfvt1T \4AY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PRO.�ECT OVER 90 DAYS DURATION. <br />