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Uate__ •_ �-95 <br />�cn��ceGon I'ar <br />PUBLIC WORKS PERMIT <br />Prin! or Type Only <br />S1lvera�rod LP l."`00 NE 1'L4th St I1206 <br />Ow�.r.r Ma�lina Atldress —�' <br />0t.-�e r <br />Appllcent Mailm� Address <br />Describe Proposed Work �ew hoUse <br />�ubl¢ Wor4t Permp • <br />Biap Oao' • 46920 <br />ruouc r�o�w� �•� s <br />rouir•, <br />�eee �orv �-.e Vun 6 <br />9eanceDue � <br />5'irkland WA 98034 922-417�� <br />CitY ZiP _ <br />Pro�ecl Addreas lil knownl ���-�`"� Site 12 <br />2iP Phone <br />Attach four 141 copies ol plens lor proposed work • Oraw lo scale antl no�e the followmg as epplicable� <br />• f'roparty Lines <br />• Outlma antl dimensions ot all eMisting antl <br />proposed structuras on Ihe lol <br />• Exlsting antl proposed uliGhes <br />• Centerline ol slreet <br />• Indicele �!orlh <br />• Show any proposAd grading chenges <br />• Show measurements <br />PERMIT CONDITIONS <br />1. All cell9 �or Inepection ahall be mede 24 h�s. in edvenca - phone ZbQ-88i O <br />2. All waik shell be peAo.med in accordence with this parmll end currant Clly el Everett Dealgn enC Conat�ucllon <br />Stenderds end Speclficetlons. <br />3. Call Locetion Underground Sen�:o 4B hrs. before you dig. TOLL FHEE NUMBER i•800-424-5555. <br />P pproved for Construclion <br />FINAL INSPECTION <br />App�ovr.A as Constructed <br />�PUBLIC NIORNS DEP! �iTMENT <br />3200 Ceder 3irnqt <br />Everett, N�A F�.92U <br />Phona:259�BB10 <br />Dete <br />AfKNOWLEDG[MENT OF CONDITIONS <br />� <br />� <br />� <br />� <br />�� <br />� <br />� <br />� <br />H <br />� <br />Q <br />a <br />Tho undersinned owne,r/npphcant hereby agrees to hold and seve harm� <br />le.ss Ihe CAy of Everet� irom any and all claims lor demeges, costs <br />erpenses, or ceuses ol pclion ihet mny e�ise because ol instellation <br />and inolntenence ol Ihe improvemenl o� other righLol-way use herelo <br />epn��ed for and furlher ogrees Ic remove seme upan nohce trom Ir.e <br />City and to replace pubhc property damagad Iheieby <br />Sign7ture ol App6cent Dnte <br />WORH AUTHORIZED BV THIS PERMIT MUST HE STARTED WITHIN <br />180 DAYS Of DAiE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILICoENTLV PURSUED 70 COMPLEiION. T�"5 PEFMIT MAV FF <br />CANCELLED BV THE GTy UfON ANY STOPPAGE OF WORH ON THIS <br />PROJECT OVER 90 DAVS DURATION. <br />