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�� <br />TYPE OR PRINT ONLY <br />Ownar <br />Describe Proposed Work <br />AppLr,aiion For <br />PUBUC WORKS PERMIT <br />PUBLIC WORKS DEPARTMENT <br />3200 Cedar Streel <br />Everett, WA gB201 259-8870 <br />�� t'�.S,TING SEP 1 � 1997 <br />Address <br />oare -- -.-1 / 22 / 9 7_ <br />Public Workr. Parmit M__�7 ,'/ C �, � <br />! <br />Bulldirg Permit M _ ---5402B. _-- --_ _ <br />Puolic Nbrky Fee E _ !� � <br />)1 �S9-4pop <br />Z'P Phona <br />Z'P Phone <br />PROJECTADDRESS(ifknown) _7Q��0'+RD_ r�.�F _ • - - <br />—I.oT 7 cxn_,« RT pl AT'�17—a5 -� � 1:� ��.« �: � <br />Aflach Iour (4) coples ol plens for prupoyetl work - Draw lo scele and note the lollowing II applicable: <br />'ProPerty Llnes �putline and tlimenslons of all evisting end proposed stmctures on the lot •Exisling and piVpt}Bed��tllitl�d•;-: `�! <br />•Centadine of street •Indicate North •Show eny proposed g�eding changas •Show measumments- ' 4' �.,.. ? 1 <br />�-..�..+� •�n���OCLVVV IFIIJLINE <br />PERMIT CONDITIONS: , <br />1. All calls lor inspection shall be made 24 hours in advance - phone 259-8810. �„� .�, -. <br />2. All work shall be paRormed in Rccordance with this permit and current City of Eyerett Design arxi <br />Construction Standards and Specifications. <br />3. Call Location Underground Service 4B hrs. before you dig. TOLL FHEE NUMBHp i-800.424-665b. <br />� ,�i �; <br />� �.;;� . . <br />F'rrp crtv elrrrk rlrnn �t :dl hmrc <br />�. �.111�� �•III�CI illll� �I(ICWNIII 111 IIIC �/IUl i4C IICW 7111i� IIIII��III:I�;CI�. 7111�' I�i11118�'C (�ICIC�U .+�I�1�� �4' Ic�l�e�c�� III <br />rfisr.irtion of d�c Pu61ic R'nrks Inspecror. <br />fi Arn' ehanre m�he dnvew:rv e�tl tnu�r hr ;�pprm�rd by Nie I'µ' Iu:p; cini. �cidlh a� prnp hnr hmticd tn <br />.xistiu� apron µidW. <br />' ldjuct w�ler hntrc ro rrsAc at end of r� � <br />k. I im'rweV. �IiflII I�e co111�ICICfy cllltd I�rf�ICh1rI It 1 C oil Il�tln <br />� ('OIIIICiI lool�ir��� <br />inno�l M tlic :tnirn rlrain;i�� rnb ��i����id �rl ai ili,• li �,W of d�: Ini <br />FINAL IN� ECTI(IiN ��� � _ � � ? <br />ACKNOWLEDQEMENTOF CONUITIONP <br />The untlersigned owner/apphcanl hereby ngrees lo hold nnd save harmless <br />Ihe City of Everett trom any antl nll claims for tlameges, ;osts, eMpenses. or <br />causes ol acllon Ihat mey ense 6ecausa of inslallation end mnintanance ol <br />Ihe improvemant or other dght-of-way use hemto applied ior and lurlhe� ngiPFs <br />to remoVe sume upon no�lCa fmm the City and to rep�nce public pmprrty <br />dameged thereby. <br />I Date � <br />Approvad as Conshucted <br />Slgnalure ol App ican �-- �- -- � � � 1&-y� _ _ <br />Dalr <br />WORK AUiHOR12ED BY THIS PERMIT MUST BE STApTED WITHIN 180 DAVS JF DATE PERMIi IS ISSUED AND THEREAFTER IS TO BE OILIGENiLY PURSUFD TO <br />COMPLETION. THIS PERMIi MAY 8E CANCELLED BV THE CITY UPON ANY STOPPAGE JF WOFH ON THIS PROJECT OVER 90 DAYS DURATION <br />