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Date_ 2-;=95 <br />Applicatiun Fa <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />Puobc Wona Parmn • <br />ama o.oi . __ 46919_ <br />PeFnc Wor�e Fea <br />Tob�fen f <br />Less �oDl Fnp Pp�p Q <br />esi.��. o�,. 6 <br />Sllverwood LP 12700 NE 12.ith St 11206 Kirkland WA 98034 822-4174 <br />Owner Ma�bngAtlr�,ess GIY ZiP Pbone <br />Owuer <br />App!itent <br />Describe Proposed Work <br />house <br />Atldress <br />Pro�ecl AoOress Id knownl Slte 1 <br />City <br />Aflach lour 14) copies ol plans �m proposed work � Drnw to scale nnG nole the lullowing ns a�ohcahle� <br />• Properly Lineg <br />• Out6ne and dlmenslons ol all ezisling antl <br />proposetl 5tr�,;ture5 on the lot <br />• Eaisting anA p•oposed utillties <br />• Center6ne ol at�eel <br />� Indicale Norlh <br />• Show nny proposed grad�ng changes <br />• Show measuremenls <br />PERMIT CONDITIONS <br />1. All calls lor inypection shell be metle 24 hrs. in edvenca • phone 259•8810. <br />2. All work ahell ba paAormaA in er.cordance wilh thie permlt and cunent City of Everett Dasign end ConslrucUon <br />Standerds entl Speclficntione. <br />3. Cell Locetion Undargiound Service 4B hie. belore you dig. TOLL FREE NUMBER �-80p•qQ4•$5$S. <br />Approved Io� GonslruUion <br />AGKNOWLEDGf_MENT OF t;ONDIfIONS <br />W <br />� <br />� <br />� <br />� <br />O <br />H <br />� <br />O <br />a <br />__ _._ lhe unCr!rsigned owner/npphcanl hP�P.by ng�ees to holA entl s,. �e hanm <br />-- less Ihe Cdy o� Everetl hom any and all cla�ms lor dameges rosts <br />evpenses. or ceuses ol aclion Ihal may arise becausa of installulion <br />nnd maintenanr.e ol Ihe improvement or other ngnbo�-w6y u�•,e hereto <br />appheA lor and lur�her ag�ee6 lo remova same upon nohce Irom the <br />Onte Gty and to replace publ�c property demeged Ihereby <br />FINFI INSFECTION Defe <br />Approv,rr� :i �, (;pnslrucletl <br />�,�UBLICWOfiKSDEPARTMENT <br />3200 Ceder Street <br />�`�-' FvereU. WA 99201 <br />Phone:259�9810 <br />Signelure o� App6canl Dale <br />WORK AUTHORIZED BV iHIS P[RMiT MUST BE 5'1RTED WITHIN <br />180 DAVS OF DATE PERM17 IS ISSUFD AND THEREAFTER IS TO <br />BE DILIGENTLY PUFSUED TO COMPLETION. THIS PERMIT MAY 8E <br />CANCELLED BY THF C:Tv UPON ANV STOPPAGE OF WORK ON THIS <br />PROJECi OVER 90 DAVS OURATION <br />