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- - ----- <br />- ----- <br />� _ __ _10/6/94 <br />I Date <br />qpplicatiou�For <br />PUBLIC WOR,�CS <br />in <br />Print or Type Only <br />kalph Scliuck 1562� 1 <br />qpplicant <br />Describe Proposed Work <br />��' �'�?STING �-1�� <br />PERMIi <br />'-' �j p C '� � � �� r^� r'� <br />If� O O Gi ��� Arn o� <br />.t �t'=)O 3' OCJ ��'� � <br />om;;����" <n ' 4'�;� <br />� � <br />-„ <br />Snohondeh )�zy� <br />^ '� -- <br />��� � c.� <br />��c1w u��r� _� <br />(i��. y_7iicr.�a.a.co_ <br />iilin9 Addres5 City <br />ilew iiouse - Basic 278 <br />Prolect Address (if knownl <br />11 IZ`1 - <br />334-0817 <br />1 Z�P <br />1 <br />Zip <br />-_ _ _ <br />-- - - - ._ <br />/ <br />Ci /�7Z <br />PupLc Wo�Ms Peimil < <br />eiaa oeo�-= 45762 <br />Pubht Warks Poe 5 -_ <br />Toial Fee <br />Less ApO�� Fee PaW S�� <br />Balance Ouc S L'� <br />Loc 2 - 112th 5� ��•� ���a"' <br />Attach tour (4) copies ol plans for proposed work - Draw lo scale and note � Ce°��erline ef streeii able: <br />• Property Lines - • Indicate Norih <br />• Outline and dimensions ol all exisling and � Show any proposed grading chz��yes <br />proposed slrucWres on the lol � gho�y measurements <br />• Existing and proposed utilities <br />� <br />E <br />PERMIT CONDITIONS <br />1. All calls for inspection shall be made 24 hrs. in advance - phone 259•8810. <br />2. All work shall be pedormed in accordance with ihis permit and c�rrent Ciry of Everell Design and Construction <br />Standards and Specifications. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800•424-555 . <br />i <br />I-�ti�.P,�'I �,�- --!��� �� <br />I Date <br />Approved tor Conslruction <br />_� - <br />�� � �, �-�-- / � /s ,- <br />I- . - . � � Date <br />FINAL'INSPECTION" <br />� Apnroved as Constructed <br />i <br />I �7 PUBLIC WORKS DEPARTMENT <br />3200 Cedar Street <br />� � ,�lYF / Everett. WA 98207 <br />, Phone:259�8810 <br />i_.__.______ <br />�___ __ � —__�__ _ _____ _ __—_ .. <br />W <br />H <br />r <br />N <br />� <br />O <br />� <br />N <br />O <br />a <br />ACKNOWLEUGEMENT OF CONDITIONS <br />The undersigned owner/aPGlicant hereby agrees lo hold and save harm- <br />less the City of Everelt trom any and all claims for damages. costs. <br />expenses. or causes of action �hat may arise because of installation <br />and mamtenance of Ihe improvemenl or oiher ri�hl-of�way use herelo <br />applied tor and furihe� agrees lo remove same upon nolice Irom the <br />Clty a�trl to repl�ce Rul�lic pr perry da�a9ed ihereby. <br />� �� � / <br />i � ` � <br />j _ r � �, _A � � <br />,��-�- �; .��t�-t�� Dale <br />Siynature�of APPlicant � ��� J <br />80RDAYSTOF DAT�E PERMIT ISEISSUED AND6THEREA T�ER IS ll0 <br />BE DILIGENTLY PURSUED TO GOMPLETION. THIS PEHMIT MAY BE <br />ICANCELLED BY THE GITY UPON ANY STOPPAGE OF WORK ON THIS <br />PRO.�ECT OVER 90 DAYS DURATION. <br />