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q0r" <br />aH <br />C <br />C: H <br />�Hrn <br />l4 0 <br />Ox0 <br />y F-I <br />H O <br />OH <br />F MM <br />G) • CC7 <br />zy3 <br />hY7 <br />HH <br />gt� <br />H <br />c� t7 w <br />�M <br />Z H En <br />Horn <br />in <br />Date1-19:92 ra"sk elat <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />Puma Walk. Parma <br />else o.pt . 92/35499 <br />Puce Wan. Foa i <br />Total Foe <br />Lau spot Foe Pao : <br />eapaa. Dun i <br />LARRY MCCAULEY PO BOX 987 LK STEVENS 98258 355-2079 OR 334-4340 <br />O it Mailing Address City Zip Phone <br />OWNER <br />Applicant Meiling Address City Zip Phone <br />Describe Proposed Work TRI—PLEX _ <br />Protect Address (If known) <br />Attach four (4) copies of plans for proposed work • Draw to scale and note the Inllowing as applicable <br />• Property Lines <br />• Centerline of street <br />• Outline and dimensions of all existing and <br />• Indicate North <br />proposed structures on the lot <br />• Show any proposed grading changes <br />• Existing and proposed utilities <br />• Show measurements <br />PERMIT CONDITIONS <br />L 1. All calls for Inspection shall be made 24 hrs. In advance • phone 259.8810. <br />2. All work shell be performed in accordance with this permit and current City of Everett Design and Construction <br />I Standards and Specifications, <br />3. Call Location Underground Service 48 hra. before you dig. TOLL FREE NUMBER 1.800.424.5555. <br />r <br />(h <br />�i l-i <br />ACKNOWLEDGEMENT OF CONDITIONS <br />Approved for Construction Date <br />FINAL INSPECTION Date <br />Approved as Constructed <br />WORKS DEPARTMENT <br />CLPUBLIC <br />3200 Ceder Street <br />Everett WA 98201 <br />Phone: 259.8810 <br />W <br />Im <br />0 <br />Z <br />0 <br />V♦ <br />0 <br />/ <br />Ida■ <br />The undersigned owner/applicant hereby agrees to hold and save harm- <br />less the City of Evorell from any and all claims for damages, costs, <br />expenses. or causes of action that may arise because of installation <br />and maintenance of the Improvement or other right -of Way uFn hereto <br />applied for and further agrees to remove same poor aotice from the <br />City and to replace public property damaged thereby. <br />Signature of Applicant Date <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHfN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />i <br />