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��� <br />A�Cx <br />ayx� <br />H x� <br />K n <br />H :U <br />O� y O <br />�Hd <br />Q H <br />��g <br />�1] Y �] <br />9H� <br />t� H H <br />gy <br />��� <br />r <br />C�7 <br />H O fy/� <br />Date�i <br />Application For <br />pUBLiC WOf�KS PERMIT <br />Print or Type Only <br />M Hultz 621 — <br />Owner <br />Renaissance Bldrs <br />qpplicant <br />Describe Proposed Work _ <br />St 9E� 5 W Ever� <br />Mailing Address <br />14705 Srookside P1 <br />Mailinq AddrCss <br />c�i _ Sd1-h St Srf•;�lU� <br />Pub�m woil'.s Pe�m�� a — <br />eina o�o� = 9 1 /2 6 723------ <br />Puelicv+orFSFce � <br />ro�a� F�� <br />��ssAooi Feeva�a 5 <br />�oc��ce ooa S <br />Gity �'P <br />Snohomish 98290 335-1487 <br />City Zip Phone <br />Prolect Address 1il krown) -- <br />Atlach four l�) copies o1 plans lo� Proposed wo�k � D�aw to scaie and note �� �����0� ne of sUeet �t����. <br />• Prope��y Lines � Indir.ab: North <br />• Oulline and dimens�ons of a'I existin9 antl � ghow any proposed qradmy chanc�r,s <br />prpposed structures on ihe lot � g�����v measurements <br />• Exist�nc,� and p�oposed ulilities <br />.....�.,r �vo�rc a�i !lW THIS LWE <br />PERMIT CONDITIONS <br />t. All calls lor inspection shatl be made 24 hrs. in advance � P��one 259•B810. <br />2 All work shall be pertormed in accordance with this perrnit and cu«ent City of Eiverett Desi9n and Construction <br />� <br />Standards and Specilications. � <br />3. Call Location Underground Service 48 hrs Gefcre You tlig. TOLL FREE NUMDER 1•800•424•55 . <br />%� , _ � .,. . - � <br />:'G(�.. !;'r-:�._ �_ _., ( ., / . ,.; ..: <br />, � ' <br />/� ,, ,- �., <br />t;� .,:i/ � �. <br />Approved lor <br />FINAL INSPEG i iurv <br />Appioved as Conslructed <br />uverett PUBLICWORKSDEPARTMENT <br />� 3200 Cedar Slreet <br />Everett, WA 98201 <br />Phone:259-8810 <br />Da�e <br />o : <br />a <br />�. <br />ACKNOWLEDGEMENT OP CONDITIONS � <br />Thc undeisu.li��=�f �iw��eUapplicunt hereUy a9rces lo hnld and save harm� �� <br />Ic.:•; �hc City o� Evcrelt Irom any and all claims lor dainages, r,osis, <br />i�apensos, or r.:mses o� oction that maY ���se hecause of installation <br />,md m�iNe��ance o� ihe �mp�o�eme��l or o�he� ngh4obway use hereto . <br />�pplicd for and lur�her agrees to remeve same upon nolice irom the <br />Gty antl to replace pu�lic property dama9ed ihcreby. <br />Datc Datc <br />Si9natwe of Applicanl <br />WORK �UTIIORIZED BY THIS PERMIT MUST BF STARTED WITHI�I <br />id0 DAYS OF DAT[ PERMIT IS ISSUED A�'D THEREAfTFR IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANC[LLF_D �Y TNE CRY UPON ANY STOPPAGE OF bVORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />