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•] M <br />0 p <br />C � <br />��� <br />� m � <br />� N M <br />� � � <br />� <br />�1 � � <br />61i <br />$ H <br />r H <br />��1 N <br />Op N <br />n O N <br />� � r <br />O � <br />( ��'� <br />I �� <br />Dale 3/9/92 <br />S-c�-za � <br />qpplicalion For <br />PUBLIC WORKS PERMIT <br />T(1 P(!STlNG__1_c__��-- <br />Print or Typ<^ Only <br />� <br />r��ei�� wmxs r,,,m��58 Z l l <br />D�M Dapt � _ —"-' <br />PubLCWorkeFee S <br />toial Fcc <br />Less AnC� Fr.e Pma 5 <br />o��a,,,��.�� s <br />Zo � <br />Leif Barem 1717 B ldest Big Lake IIlvd, Alt Vcrnon 422-6025 ��j`Z�%� <br />Owner Mailing Atldress � Ciry . 7ip Phone <br />Atldress ���Y <br />Describe Proposed Work N�W <br />��E <br />Prolect Address (if knowN <br />Phonc <br />Attach four (4) copies ol plans lor proposed work - �raw lo scale and note the lollowin� as applicable: <br />• Property Lines • Centerline ol sireei <br />• Outline and dimensions of all existing and • Indicale Norlh <br />pmposed siructures on the lot • Show any pmposed gradinp chan�es <br />• Existing and proposed utilities • Show measuremenls <br />E <br />PERMIT CONDITIONS <br />1. All calls for inspection shall be made 24 hrs. In advance - phone 259-$810. <br />2. All work shnll be pedormed in accordance with this permit and current City ol Everett Design and Consiruction <br />Slandards antl Specitications. <br />3. Cell Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1•800•424-5555. <br />�I, S e.ve.r� ��^'� P <br />SG�- o� <br />II�.e ska�/ �L.?cl,ar�,e �'�fo �?dK�'�. <br />W <br />� <br />� <br />N <br />� <br />� ���✓a f� �✓v�K✓�j �L�..,� c��tv,�t� �lo� accr-o5f O <br />/ �/Zv4J .� s-�anda✓d si�� s��✓ � M�,y' . �/� <br />�Pr'lva� i c'�-G.� 7 V♦ <br />� , O <br />P,,...��=����-,��� a <br />, <br />A IKNOWLEDGEMENT OF CONDITIONS <br />The undersigned owneqapplicant hcreUy a9rees to hold and save harm� <br />Iess the City of Everelt Irom any anA all claims lor damages, costs. <br />expenses, or causes ol action that may nrise because o� installation <br />3_2—�_GZ and maintenance ol the improvement or other rie�ht-ol-way use herelo <br />� applied lor and lurther agrees to remove same upon notice Irom Ihe <br />Date City and lo replace puhlic p�operry damaged thereby. <br />L <br />Approved �or Consiruction � <br />'� � <br />� - — <br />FINAL INSPECiION <br />qpprovetl as Constructed <br />,A�� PUBLIC WORKS DEPARTMENT <br />� 3200 Codnr Slreet <br />� Everett, WA 90201 <br />Phone:259�8810 <br />,. . _ ->� <br />Datc <br />S.9nature o� Applicant • """ <br />NORK AUTI�IORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />160 DAYS O� DATE PERMIT IS ISSUED AND TIIEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY RE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WOFK ON THIS <br />PRQJECT OVER 90 DAYS DURATION. <br />