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TYPE OR PRINT ONLV <br />Owoer <br />ApPhcabon Por <br />PUBLIC WOAKS PERMIT <br />PUBLIC WORKS DEPARTMENT <br />3200 Cedar Street <br />Eve'ett. WA 98201 259-8810 <br />'". POSTING FEB 0 9 19`� <br />12 BOT� <br />g Address <br />Describe Proposed Work __ NEW NOUSE - BAS <br />PROJECT ADDRESS (if known) <br />1 75TH ST SE <br />=ov�o�J 0 <br />1 M OJ V O b� <br />OJ f� <br />E MIL��6���nc`�g� <br />City <br />c- <br />;�. <br />� <br />�� ..�� <br />-i '1R V fJ1 � (n <br />1246 <br />_ LOT 2 <br />Ll <br />r- <br />10�9�� / <br />Datx-----.��'i�-�--�— -- -__� <br />Public Warks PerroQ M _. ��/3 %� <br />w ---- <br />Building Permil N = 56130 <br />rr------ - <br />Pubiic Works Fee S <br />V M V O V] --��'-- -- <br />ON 00( c� <br />a <br />rnv�m <br />Au;,ch low (4) copies of plans lo� proposetl work - Draw lo scale and note the following il applicable: <br />•P�operty Lines 'Outline nnd tlimensions of all existing and proposed slmctures on the lot •Exisling and proposed utiliL � <br />•Cenledine of street •Indicato Nonh •Show any proposed g�ading changes •Show measuremenls <br />PERMIT CONDITIONS: - � �""' ` y"v" ' � ��� `���` <br />1. All calls for inspection shall be made 24 hcurs in advance - phone 259-8810. <br />2. All work shall be performed in accordance with this permit and current City o( Everelt Design and <br />Construction Standards and Specilications. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800-424-5555. <br />i <br />RNAL INSPECiION <br />'�i � ill m nilt�hriunn h�nrh huilr,�.: ��,.i. �,..�,�tnn i-' 6'•mrl I imir�• qn�l'I';d�l,� 7.) ? ofih�• cih� <br />���im�c;u:i \t:ume •w�•w \iannal Ico�y ,.hq�l •�I to Ilu. prtmnl Ihe mtilhruiou tr��och alinll be n <br />i.: : i Il�wi � I�:I lu :w� up ,lu�i: pruprih lin� rt f��uwl�diuu uor clueci tlum I!� 1: rl �o twt Jui�u;l� <br />� y ih. hu; or Ii,un;L�hou. ('oll Pnhhr \l'ori;: tur ,ui in::p:•ci�on pi ior In co� crinc frrnch:•: I <br />��i;ni i hi, ,�rnchn':• h�u �„ �io� I <br />1 I �� :�q I i nf nn�vrt� iou. ruot mi�s� llir� lun• <br />�i ;i �.uil cl�u. ul'lann�-,�uii�/i. �i,,.wu:J aud Ihr inlilh�ihuu h.•uch i, a�,i:.iuc�,,I <br />�i�. _,l�•r � mrJ.t/1 ��irl �. li'om I�iLI:� i-'_� Ih; Ircuch .hould l�: !� <br />(_� _�_�_i�i;. <br />�I �,�m.lilin�r iii fhe liclil ��iu1� hrnn �h��zp iii Ilu� ��f�31111�1IP - 11(I�II�� fICCIIi'Illlu•I� <br />r uie ;ii. .�L,��-, iu� uUu�rr�l I;�LI�� ;in :i ¢iu�l � <br />ACKNOWLEDGEMENT OF CONDITIONS <br />�C„/_ �� The undersigned owner/npplirnnl hereby agrees to hold and yave harmless <br />/ rvr the City ol EvereO fmm any and oll clalms (or dmnagas, costs, expenses, or <br />o;�E. / causes ol aclion ihot moy arise because of installation ond main�enance of <br />the improvement or olher right-of-way use hereto applied fa and lurtha agrees <br />to remove same upon notice Irom tha City and lo replace public property <br />Z ��p —SS' Aamaged Ihereby. <br />Dale <br />Appiaved is Consiructed n <br />Si9 �e ol ApPli[a���" \n+� O� / (!' / � <br />Date <br />WORK AUTHORIZ[D BY 7HIS P[RMIT MJST �E START[D WITHIN 1B0 OAVS OF DATE PERMIT IS ISSUED AND THEREAFfEq IS TO BE DILIGENTLV PURSUED TO <br />C.'1MPl C TION THIS PERMIi MAV OE CANCFLLGD OV iHE CIN UPON ANY STOPPqGE OF WORN ON THIS PROJECT OVEH 90 DAVS DURATION. <br />