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__ � � i <br />5-13-94 vim��c Wm�s a��mn s <br />Date �i1�a <br />e�nq oPu�. • — <br />ApPlication Fo� <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />Penbc\vorls�ee s <br />Total �ee <br />l¢SSA00� Fe✓FT'.:1 S <br />BT�AnreOJG S <br />Bamhart Marty/Sue 5021 Sound Ave Everett_98203 347-6647n pry�n�� <br />OwnP.r A^2���fb: 4SdrGss Cit�• <br />Ovner <br />M:,iliq;� Address <br />Oescribe Proposed Work neiJ g8t8ge__ <br />PrOject Address lil known! 5021 Sound .1 <br />Attach four (4) coP�es ol plans Iw nroP�se�f wo�h �❑ <br />• properry Lines <br />� Outline and dimensions ot all exisLnq i <br />proposed siructures on ihe tot , <br />• Ezisting and proposed utilities <br />Z�p Phone <br />INITIAL INiPECTION <br />. . ,. KIRK BROOK8 <br />oAtr . /G %� <br />/I" �v`� �rr+�f /�(�SNtf►C.Y <br />PERMITCONDITIONS �� /�pn/�P/N�y/1 O� P%i��7/N� -�iGrG`�_ <br />1. All calls for inspectlon shall be mede 2� ir / � <br />2. AII work shell ba pedormed �n accorda� _ ' <br />Standerde end Specilicatlons. �"'�i'�"� <br />3. Call Locetlon Underground Service 48 hrs. before you dig. TOLL f11EE NUM�EII 1•800�4i4•5555. <br />PUB NOTW EOUIREO MIT <br />BY <br />OATE s <br />� —_ <br />Approved tor Constructlon �"��' <br />FINAL INSPEGTION ���� <br />Apptnved as Constructed <br />�PUBLIC WORKS DEPARTMENT <br />3200 Cedar Street <br />EveretL Wh 98201 <br />Phone:259-BB10 <br />ACKNOWLEDGEMENT OF CON�ITIONS <br />J <br />� <br />�w <br />'I <br />C <br />� <br />� <br />O <br />a <br />Thn undarsianetl ownei/apphcant hc�eUy agree5 to hold and save harm� <br />iess the GtY oi Everett lrom any and at1 c�aims lor damages, costs. <br />�rpenses o� causes o� aclion that may anse 6ecause ol inslailation <br />anA mmntrnanr,e n! Ine improvement or olher right-o��way use hereto <br />�;;pnnC for antl �urther anrces to remove same upon nolice irom ihe <br />C,!�..��.,� t� i��placa f��Ulic prooeity uamaged ihereby. <br />Siqnatwe of AnPlicant <br />Date <br />WORK AU7HORIZED BY THIS PEPMIT MUST BE STP,�iCC WITHIN <br />�90 DAYS OF DATE PERMIT IS ISSUED AND TNEREAFTER IS TO <br />BE DILIGENTLY PURSUED 10 COMPLETION TNIS PERMIT MAY BE <br />C�"JCELLED BY THE CITY UPON ANV SIOPPAGE OF WORK ON THIS <br />PRO.IECT OVER 90 DAVS DURATION. <br />