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Date »-� 5-92 <br />Appllcatlon For <br />PUBLIC WORKS PERMIT <br />Frint or Type Only <br />.•\ I Pubuc Worb Permq • 3 Z 9 z <br />IBiop.Oeo� • 39006 <br />PuELe Wo�h� Fea <br />�oblFea s - <br />lan �p0� Fae V�iE S_ <br />B�bnnDee S 2O <br />Bil]. Guetaveon PO Box 2702 Lynnwood WA 98036 788-6920 <br />7wn ir -� Meltlng Addresa _ City Zip Phone <br />Owner . <br />Applicant Melling Address Cily Zip Phone <br />Descrlbe Pruposed Work neW dupleX <br />Prolect Address (il known) ��z � C � — <br />� <br />Attech lour (4) coples ol plens for proposed work • Draw lo scale and nule Ihe lollowing es applicable: <br />• Property Llnes • Centerline of straet <br />• Outline end dimensions ol e�l exlsting and • Indicate North <br />proposed slructurea on the lol • Show ei�y proposed grading chenpes <br />• Exisllnp end proposed utilitles • Show measurements <br />PERMIT CONDITIONS <br />1. All calls lor inspoctlon shell be made 24 hra. In edvance • phone 259•8810. <br />2. All work ahall be peAormed In accordence with this permlt end currenl City ol Everett Design and Conatruclion <br />Stenderda end Specificetione. <br />3. Call Locatlon Underflround Service 4B hra before you dlg. TOLL FREE NUMBER 1•800•424•5555. <br />s� ,�,�..�.� ,���y� �� ���e .� -� � -�-�t� <br />� .s.��•,.�� �.��� � � � - o� �f , �;Y,.�..-�.�0 <br />op��-�'� cona�� <br />�� ik�i,� rLrrr%- -�%�' ��' �"L�".O . <br />��o� cv��(e�c� <br />" y�2n/�r7 <br />�.r.v���/� � 7/�� <br />ApprovedforConstruclion 7 Dale <br />FINAL INSPECTION � Date <br />Approved as Construcled <br />S��PUBLtC WORKS DEPARTMENT <br />3200 Cede� Slreet <br />Ev9relt, WA 98201 <br />Phone: 259•BB70 <br />yJP.I � W il� VP l t �wU d �Q�Qc' <br />W <br />H <br />� <br />ACKNOWLEDGEMENT OF CONOITIONS <br />The u�dorsigned owne�/applicant hereby egreas to hold and seve harm• <br />Iess the City ol Everelt Irom eny end all claims lor demapes, costs, <br />eHpenses, or ceuses ol ecllon Ihal may erfse becausa of Installation <br />and malnlenanr,e ol Ihe improvement or olher righl�cl•wey use herelo <br />applied lor and lu�ther agrees !o remove same upon notice Irom the <br />Ci�v and to replace publie proper)y �ir9e�ped Ihereby. <br />i nalure ol ApP iCan� Dale <br />ORK AUTHORIZE� BY THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCFLLED BY THE CITV UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />