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Date 3-23-95 <br />.n u u 11 ' 1 �u �lU{� m¢ won. Pnrmn . �� / O_ —_ <br />? ; ':)STIN� =,r �� � � JrGiaaorn�. 67a�g — <br />Application For � ----- <br />PUBLIC WORKS PERMIT P°°;a�:Fa �°° : - <br />• � •a. �oo� �Pe Pa�E S _+� <br />.. . . '. , . BeianyrD. S !� <br />Print or Type Only <br />Owner <br />Patrick Franssen 13619 Mukilteo Speedway 1l401 <br />Owner <br />9b037" 337-0549 <br />Matlm9 Adtlress ' � CiIY ;;' � ;:- �Z�p , , . . . <br />, , <br />, 'r <br />AdAress <br />Describe Proposed Work neW f10USe ______ <br />Prolett Addrese Id known� <br />Cily Lp Phone <br />Attach four 14) copies ol Ulans lor proposed work � Draw to e.:ale and nota ine lollowing as applicable: <br />• Property Lines • Centerline ol streel <br />• OutGne and Aimensions ol all e�isting and • Intlicale Nor�h <br />proposed siructures on Ihe �ot • Show any proposed gratling Chenges <br />• Eaisting and proposed utildies • Show measurements <br />INE <br />PERMIT CONDITIONS <br />1. All calls for insueclion shall be mede 24 hrs. in edvance • phone 259•8810. <br />2. All work shall be oertormed in accordance with this permil end currenl Cily ol Everetl Design and Construction <br />Stander65 anr Specificallons. <br />3. Call Location Underground Service 4B hrs. belore you dig. TOLL FREE NUMBER 1•800•424•5555. <br />i R����Ro�� drain�oo sh�ll h�• dis�harq�•rl� <br />• 10 �he ailc's stonu drnin �y,l�•m I�n �• U� or public) <br />• 7'oaresiJculialroofdo��nc:pouln�:!��m�I�•.iwicdp:r.«liuul-9.�luflhr <br />cil}' sl:tndrvds <br />. �:filo xp!n�h hlockG <br />1Le rnelhod aelcclzd will br �ul�j�•ci tu Puhlic W'orks Urp:ut��mrid sipprov;d. <br />Approvetl � s Constructetl <br />�Iri`/ PUSLIC WORKS DEPARTMENT <br />� 3200 Cedar Streel <br />Everott, WA 98201 <br />Phone:259�BB10 <br />� <br />O <br />� <br />� <br />O <br />a <br />ACKNOWLEDGEMFNT OF CONDITIONS <br />The underslgned owne�/appGcant hereUy ag�ees lo hold and snve harm� <br />less Ihe Ci�y- I Everel� Irom any and all claims lor tlamages. cnsts. <br />eMpensrs, or c�uses ol aclion Iha� may ari5e beCause ol in5tallition <br />and maintenance I ih�: ,mprooement o� other ughbobway use hereto <br />applieA �or 0nd 1 iher HgreeS �o removn 58me upon nolice Iwm Ihe <br />City a o replac pub6c property damaae6 thereby. <br />�/ !�l�7�� <br />Sig ture o� Ap, �cant ate <br />WORK AUTHOHIZE� BY iH15 PERMIT MUST BE STARTEO WITHIN <br />180 D�Y3 OF DATE PERMIT IS ISSUEO AND THEREAFTER IS TO <br />BE DILIGENTLV PURSUED TO COMPLHTION. THIS PERMIT MAV BE <br />CANCELLED BY THE l:'T'1 UPUN ANY STOPPAGE OF WORK ON THIS <br />PFOJECT OVER 90 DA'/S �URATION. <br />