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�:-:`<: <br />� <br />� <br />e,:,��:� <br />��x <br />C", H <br />9 H C/� <br />C <br />H � <br />� H� <br />"C� N htl <br />fA H <br />z <br />��d <br />OH <br />H�g <br />ij] Y (�] <br />t� y 7. <br />HH <br />g� <br />�d� <br />� <br />zy� <br />H O tn <br />D ate 12L3/92 <br />Applica�ion For <br />Pf�6UC WORKS PERMIT <br />Print or Type Only <br />TROLL, IIILL & KATYY <br />Owner <br />Owner <br />qpplicant <br />Vup�,r V:orts Pc�m[ v <br />e,�noem.•3$8�5— — <br />PuOh[WorxsPoe 5 <br />TomlFee <br />Lesshppi FecPaiU 5 <br />Balance Ooc � <br />213 - 99th St SW Everett 98203 <br />Mailin9 Atldr=ss City Zip Phone <br />Address CdY Zip <br />Describe Proposed Work Addition F Garaae _—_ <br />Proiect Address (if known) —_ <br />Attach lour 14) copies oi plans for proposed wo�k � D�aw to scaie antl note the tollewing as apUhcable�. <br />• Propeny Lines <br />• OuUine and dimensions oi all exishng and <br />proposed st�uctures on the Ict <br />• Exlsl�ng and p�oUosed utiliiies <br />IT[ <br />• Centerline el sireet <br />• Indicale Norih <br />• Show any proposed 9radiny chanyes <br />• Show me.suremenis <br />PERMIT CONDITIONS <br />1. All calls lor inspection shall be mzde 24 hrs. in advance � phone 259•8810. <br />2. All work shall be pedormed in accordance with this parmit and current Ciry of Everett Desi�n and Construction <br />Standards and Specificalions. <br />3. Gall Location Undergrountl Service 48 hrs. bebre you diy. 70LL FREE NUMBER 1•800•424•5555. <br />Afnroved lor Coostruction Date <br />FINAL INSPECTIJN <br />Fpp�ovetl as Consirucled <br />�'V��11 pUBLICWORKSDEPARTMENT <br />�� 3200 Cedar Street <br />�ss Everett.WA90201 <br />Phone:259�8810 <br />PUBLIC WORKS PERNIT <br />NOT REOUIRED <br />�v_ �' ✓ <br />DA1r' ��"y-iz <br />�\�KNU�VLEDG[61[NT OF CONDITIONS <br />W <br />� <br />N <br />� <br />O <br />Thu unders�gned owner/npU��can� heieby a9rees to hol[i and save i'ann- <br />Iess Ihe Gly ol Everetl irom any and all claims lor dama9es. :osts. <br />expr.nses. o� causes of action lhat may arise because o� installa�ion <br />antl mcuntenance ol Ihe improvemenl or o�her righ4ol�way use herelo <br />applied for and luriher a9rees �o remove .ame upon notic.: from �he <br />City ����1 to replace puUhc proPerty dama9ed �hereUy. <br />Dai� I �ate <br />$iyna�ure of Applicant <br />WOFK AUTHOHIZED BV THIS PERMIT MUST BE STAFTED WITHIN <br />tA0 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />9E DILIGEMTLY PURSUED TO COMPLETION. THIS PERMIT MAY 8[ <br />CANCELLED 3Y THE CITY UPON ANV STOPPAGE OF WORK ON THIS <br />PqOJFCT OVER 90 DAYS DURATION. <br />