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.., -- ,J -, <br />, . _-_ _-av�.� .�.rn��' 'M �( ���4 r� Y �.'i. n, <br />Date 1 94 90�` , � , , `". , <br />Application For <br />PUBLIC �i4'ORK� �ERMBT <br />Print or Type Only <br />t+— _—'_"'_—_—_ _..__.__. "__-.. — —_-__-_" <br />i� . .. . . . , - , ,�; <br />IPubl¢ WorFs r^e�mll + _ �/ --- <br />siae o�o� < 90/23 1 <br />PWL� �Vorks Fro <br />Tul�l Fec 5 <br />Less ApP�� Fee Pdid $ �/ /� <br />BYaGU! UbC S� _.t. "~ <br />Se1eCt tiolr,e^ P.O. ECX 708 blukilL-eo, WA °�'?75 J?.?.-319G <br />Owner Mailinc� Address City Zip Phone <br />0!aner <br />Applicant <br />Mailinq Address <br />City Zip Phone <br />Describe F:oposed VJork 1dEz���single fami� residenca Lo_t 7.3_Gle�nhaven 1lei�cht�, _ <br />Prolec� Address (if known) <br />Atlach four (4) copies of p!ans fo� proposed work � Draw to scale and note the lollowing as applicable: <br />• Property Lines <br />• Outlin? and dimensions of all existinc� and <br />proposed structures on the lot <br />• Exisiing and proposed utilities <br />• C�nterline of street <br />• Indicale North <br />O Show any proposed gradinc� changes <br />• Show measurements <br />I'ERMIT CONDI'fIONS <br />t. All calls for inspection shall be m..-�e 24 hrs. in advance - phone 259•8810. <br />2. All work shall be pedormed in accora��ce with this U'-•rmit and current City of Fverett Design and Con:Aruction <br />Standards and Specifications. <br />3. Call Location Underground Service 48 hr:�. be(ore you :ig. T'OLL FREE NUMBER 1•800•424-5555. <br />r�;�.� cr{r,iac� �t; Tr�r n�zr;�.�.._.,� ��o<<� t����:�•,1� ���:�. ^.,�r•;,��vr,;r, <br />�Y Tiili PUflLIC '�70RK� 'f7��':iCTOR. <br />COPINECT DOWPi�F00TS TO �j-9tj�3—iiRf:�-k�6-. Fvo��c. �r_,a�,�,+,UE sYsn:i-�. <br />.I'Gi'P CITY S'PF�f."PS C1,I;AN AT ALL TI[9GS. <br />!�.fdY DAPtAGG TU 7'H;�: '�illtR hP]D SIDF_,WAL}' !JTLL <br />'T:-; �l�r�r ..TII'����',.��Ci�'i� C�r 'i'i:i�. I'i,tt�,.,1" `.'.�`? .. <br />G <br />ApProved for Cons� _ / —�ate <br />�'�/jC�` " %/!J— J�D <br />FINAL WSPECTION Date <br />Approved as Constructed <br />everett PUBLIC WORKS DEPAR7MENT <br />� 3200 Cedar Street <br />Evcrett, WA 98201 <br />Phone:259�8810 <br />Pr aerr>>; .,. <br />r <br />ACKNOWIEDGEMENT OF COND�TIONS <br />� <br />� <br />� <br />�e r <br />C� <br />�� <br />The undersigned owner; applicant he�eby aqrees to I�old and saa�� harrr I <br />less �he City ot EverMt Irom any and all claims rnr dama:�es. cosis � <br />ezpenses. or ceuses of :�ction thal may arise because ol installa�ion ��� <br />and mainlenance ol the improvement or other ri9ht-of-way use herelo �� <br />applied for and luriher agrees to remove same upon no�ice Irom Ihc � <br />Cdy and lo replace public property dama9ed !hereby. � <br />��'S��C%. l �,�^----' ,�'i.7'�%rz— <br />Signature of Applic nl D•a•.a <br />WORK AUTHORIZ�D 8Y THIS �ERMIT MUST BE STARTED lh'ITHIN <br />180 DAYS OF DATE PERMIT I: ISSUE� AND THEFEAFTF:R IS "i0 <br />BE DIUGENTLY PURSUED TO COMPLETION. THIS PERMIT f�1AY c,C <br />CANCELLED BY THE CIiY UPOi' ANY STOPPAGE OF WORK flV THIS <br />PFJJECT OVC-R 90 DAYS DUHATii„':. <br />