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3�,zt�95 , PuohcWmhvPe�mn• � <br /> Date B�aa o.o� • 47 O1 <br /> �-� <br /> qpplicalion For �� _. <br /> PUBLIG WORKS PEiiMIT =; PueTa�Feeiee , <br /> ,. <br /> ". Lee��oo� Fee PnG s �� <br /> � - �j - �i� ;�; � p �a��e�-� �;: <br /> Print orType Only ?0 POSTING J — — m � � < <� � o o �� <br /> G ... .-. .� :a .n r�: <br /> M M <br /> � W A <br /> Goldmark Gnt. 915 Stitcii Rd T.k Stevene 98258n , m 334-9u56 <br /> � �ip �.; j c� �- Pho:�e <br /> Owner Madmg Address C�IY � � n �i �i n �� F > iii <br /> enrniE:� �' ;nni ;'�� n:� i; <br /> O <br /> APPIiGan� <br /> � ailing Atlaress Gry Zip Phone <br /> New duplex - Bae1c 315 <br /> Describe Proposed Work — <br /> W <br /> ia���c�i P�- .s�. �_ L � - �— <br /> Projec�Ad Jress 1�1 knownl ' <br /> Attach lour 141 copies o� P�ens for proposed wo�k• Draw to scale and nole the lolloWing as apphcab�e: � <br /> • Property lines • Centerhne n!streel <br /> • Indicale Noi�h <br /> • Oulline and dimensions ol ell eRislmp and � Show any proposed gradmg changes <br /> proposetl siructures on Iha lot � gh�w measurements M <br /> • Existing �nd proposed utiGtics W <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT i.ONDITIONS � <br /> 1.All calls for Inspection shall be made 24 hrs.In advance•phone 259•8810. <br /> 2.All work shell be performed In eccordence with this permil end current City ol Evarett Design end Consiructlon <br /> Stenderds end Speclllcations. � <br /> 3.Ce�l Locallon Undarg�ound Sarvice SB hrs.befoie you dig.TOLL FREE NUMBER 1•800•424•55 . <br /> J IFPO � Ilp:hP!•I� !IPUII�:II !Dllilnf'S. ,. _. , 1 . 71 ].j, ) J� 1:"' 1 � I �nr�nllha � <br /> ('�qfJr��il�(�� r��vlel,�P�.Y9.� I�i�hn�Jl•7t �pnnn,ni �n. i��'��1_rpror r �. I��eirp�o. l��nrn�naht�ll!�nr.��)(7! <br /> Jn�iellon of Il�e Pu�lic, vvo��� ���'�uE�iui. <br /> n.nv chanqe m Ihe drivewaV�'!�r,�int be approved bv�hA PW Inspeclor wicllh al prop Une Ilmlled 10 evKenia � <br /> �prr,n vrldlh. � <br /> ,4a��51 waler hoxes lo qrade a1 entl of c ornti;�:lion. <br /> ° CIII IPnCM O�C1iOf O�hC?f Pf(KIOfI fOflif0l tf�PCKIJfPS cMll bP IfK.I(IIIPd hV IhP bi 1'!(1Pf Ol IhP(�IfPC�IOfI OI IhP Pi d)II( O <br /> 'iJGf15�fA�i2CIGi. <br /> HOOfiOp dfC]IOC7qP ShClll U@ dKChOfr.�PU: <br /> ,,.,�� I.".�.( 7.R.o C:>�inect lo ihe nlat4 storm drain syslem. �st��b k provided at Ihe tront o! th•r I�I. � <br /> -`��,�� �, i c,n��cc I lo !,ie lofs individuul tiench di aln N�ovlded al Ihe reai ol eacl i lol. <br /> ,-rn,n�n: r cu^n,�K.i f>F t<U en no� lo d�sn�pl Ih�area of Ihe t�ench drrnni <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> ,��1��(„(�i� The undervgned owneq0pplican�he�ebY agrees lo hOld 0�d save harm� <br /> '! 1 --- less Ihe Gity of Everetl Irom any end all claims br damages cosls <br /> � / ezpenses. or causes ol action that may erise beceuse ol installahon <br /> G�� ?/�'7�/(— and maintenance �' the improvement or olher right�obwey use he�elo <br /> J > �� �v applied lor and I�..�ier agrees to remove seme upon notice Irom Ihe <br /> Ap rov�Construr,iQn <br /> Date Ciry and to reU��ce?ublic property demaBed �hereby. <br /> / / - S j� �� <br /> INAL INSPECTIO e�e Date <br /> - SignaWre ol Applicant <br /> provedasConstructed WORK AUTHORI2ED BY fHIS PERMIT MUST BE STARTED WITHIN <br /> �-7 PUBLICWORKSDEPARTMENT 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> 'V� 3200 Cede�Slreel BE DILIGENTLY PURSUED TO COMPLETION. 71115 aEFMIT MAY BE <br /> Evere��.WA 98201 CANGELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone:259�BB10 PROJECT OVER 90 DAYS DURATION. <br /> I <br />