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, <br /> -� <br /> � <br /> , <br /> _ ------_ -- ----�f <br /> �.-12- 2��r .._ / <br /> , Pu�l¢wo�Ms Pe�mil• I `� <br /> Date ;-i1-9' 36186 <br /> eioe ueo� • i <br /> APPIiCalion For _ I <br /> PUBLIC WORKS PERMIT Publ¢1YorkeFeo 5 _ <br /> -93 ,�,a�Fea , <br /> TO POSTING � LessApo�FcePaid S ; <br /> . =— o��,�.:�o�� S Z.d — �, <br /> ��� � Print or Type Only I <br /> y i <br /> 9�x <br /> f~/� Himalaya Homcs 10217 19th A�e SI: iivcrett 9H2O8 33R-1944 Phone <br /> H �� ', Mailin9 Address Cily 2ip i <br /> Owner <br /> H H � <br /> @ <br /> � H� � Ownar <br /> '��' H'"+�4 �� App� Mailin9 Address City ZiP Phone <br /> licani <br /> C/�H <br /> yzr <br /> � y� � Describc Proposed Work neea con:.[ructjon SFR <br /> OH � .. c. .i . i <br /> H �8 <br /> n� o W <br /> xy� r <br /> � F..�y �� project Address lif known� lR C7 e�wood AVe <br /> N � <br /> �"� A�lach lour(4)copies ol plans lor proposed work- Draw to swle antl nole ttie following as appllcable: <br /> O Cy V7 � • Centerline ol straet <br /> qq • Properry Lines • Indicate Norih �� <br /> 3 L�7� ; • Outline and dimension<_of all existing and <br /> T proposed slructures on the lot • Show any proposetl 9radiny changes <br /> yp y ', • Ezisting and propos�!J utilities • Show measurements . � . <br /> I DO NOT WRITE BELOW THIS LWE O <br /> �. .. ..w-�"' ' <br /> � � PERMITCONDITIONS <br /> � 1.All calls for inspection shall be matle 24 hrs.in advance-phone 259-8810. � <br /> � ' 2.All work shall be pedormed in accordance with this permit and current City of Everett Design and Construclion ^ <br /> �� Standards and Specilications. <br /> ��i 3.Call Location Underground Service 4C hrs.bebre you dig.TOLL FREE NUMBER 1-800•424•5555. � i <br /> i <br /> �~� - <br /> � � � � �/�� <br /> � � �' �v,����� cv � ��/ �:� �� ��c�, ������� `' � _°� �t� � l!�'r �' �I <br /> � -� I -�_ �� c�J �/� <br /> � � /2v �_ .; — <br /> � v� , <br /> �� � I <br /> �-� �- <br /> a . <br /> :. � ,, <br /> JC� ... �n i � 1c T! O R� =Z ?i N :pt k= ]^ '� i� i:i Ct n ., 1:: J '_ U �S <br /> [� m Y �� o u �T r�I6p q-y �p r Nn m ACKNb�V�IL�QGEM�NT OF CONDITIONS <br /> 1^I 1 v � ` p g � � 2 G) f.l O !+1 O � � A 2 G1 �}r� ._ I�1 O F� <br /> .�.,<„e. �41 . � � � � W � _ � n �+ �' � �he�uFdersignetl Q}¢rLo�/����clnlhereby agrees to hold and save harm- <br /> , less the Gty of F�p�erell Ir§tli arr"y�and all claims lor dama�es, cosls, <br /> � /� y. � w � eKpenses. or cauSCs Q� acGbn mai may arise because ol inslallalion <br /> J / � � "` N, ;'� a ��,•CC�'c"- -�",._=, er�I�nain1gnt�ncC of �he,��n, roverient or other ric�ht-ol-way use herelo <br /> I U/� � �� 1 � �Q�� ^� � "' �� xppfjei���ar unc���urtber a9rees tm-remove same upon notice irom Ihe <br /> d� � �, � I f IA A 1 • <br /> �� qpprovetl far Con�{uction A g S ,o i� cn a o4��� �� 6itY,m]d to rePface pubhoProperty.damaged ihereby. <br /> .J (] O O O O r � 1 lJ 1 �-J '� �-� r.-� <br /> � � � O <br /> 3. J 7 -`l � � <br /> �` � � ,���_' . .�" . �: /" : �C1ri <br /> Dote — ��O".� � <br /> � FINAL INSPECTION Signatute'ol Applicant c� �' ' Date <br /> '�, Approvetl as Constructed <br /> j WO�RK AUTHORI2ED BY THIS PERMIT MUST BE STARTED WI7HIN <br /> �, ��r� PUBLICWORKSDEPARTMENT 180 D�YS OF DATE PERh11T IS ISSUED AND THEREAFTER IS TO <br /> 3200CetlarStreet BE DILIGENTLY PURSUED TO GOt�1PLETION.THIS PERMIT MAY 8[ <br /> Everetl,WA�38201 CANCELLED BY THE CITY UPON:ANY STOPPAGE OF WORK ON THIS <br /> Phone:259�BB10 PROJECT OVER 90 D�YS DUFATION. <br /> i <br />