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� • ApP�'Calion Par <br />PUBLIC �1NORKS PERMIT <br />PUBL�(', WORNS DEPARTMENT <br />�200 Cedar Street <br />Evere� WA 38201 259-8810 <br />r'� <br />]: f.] � C] US fj � fj CJ �J t��i <br />TYPE 0!i PRINT ONLY �^ P p � M �; � � r:� o oi <br />�] M w� M . M yj f�� � <br />Y K M <br />BORSETH CUSTOAI HONES <br />Owner <br />Describe Proposed Work <br />mannig <br />i� P�JSTING <br />SEP 1 � �y�� <br />Date__10/3/96 _ <br />Public Works Fermlt N _ __ ��39t� _ <br />awidmq Pe�mu a _531DJ_ <br />Publlc Works Fea E � <br />STATE AVE°: PfA@�Y' SVTf.LE"VlA 98270 653-3720 <br />m <br />� �i � u � � � �Q '# ui ci � [ip <br />7D� F4 ��i5 r.�i �% t�t�i in 77.5 t�_=i <br />_ NEW HOUSE — <br />PROJECT ADD��SS (if known) 7:�..3 3!Y� cs'� �J E t.oT 5 MT vt F•w vT.r. <br />Attech lour (4) coples ol plans lor proposed work - Draw to scale end note Ihe lollowing II eppliceble: <br />•Proparty Llnes 'Outline ond tlimensions ol all ezisting end proposxd ;tructures on ihe lot •Existino and proposed utilities <br />'Centedine ol streel •Indicale NoAh •Show ony pruposed g�r.d�ng changes �Show measurements <br />DO NOT WRI'fE BELOW THIS LINE <br />PERMIT CONDITIONS: <br />1. All calls tor inspection sh311 be made 24 hours in advance - phone 259-8810. <br />2. All work shall be performed in accordance with this permit and current City of Everett Design and <br />Construction Standards and Specifications. <br />3. Call Location Underground Service 48 hrs. betore you dig. TOLI FREE NUMBER 1-800-424-5555. <br />� fie�•p city ct�cc�s cican at all timr�. <br />� t'mb E�ulter and siAcw�JF. ui ihr plal ;u: u,�� :cid iu�d uua�•: �I. nnt dauci��r Ih:icto •hall Lr r �,lac: d al <br />disa:fion ol'll�r Public �L'orf:: fuspcc�m. <br />Ad�u�l walcr boxc� f0 !Te(IC 11 CII(I 0� COf1�1I11C�lUl1 <br />I)rivcw;ry�s ,h;dl Lc complctcty� cuicd bc�brc d�i��nr� �,n thrm <br />Rnollop drain:�rr cliail b; discharycd <br />���i, I-I : v, rm :�ppiovcJ iulilUotion treuch a.; pci plau staplcd i i � ,. <br />I���: �'.' � ��, ;h; ,�unn drnin;i� � �hih �,ta�ided a� th�• ���a! of th <br />� <br />t <br />/'c�'% � <br />Approved es Constructcd <br />� <br />� <br />O <br />♦�� <br />V♦ <br />O <br />a <br />ACKNOWLEDOEMENT OF CONDITIONS <br />fhe undersignatl ownndnpplicant hereby ag�ens to hold and sava hertnless <br />the City of Everett irom eny nnd all claims for dameges, costs, expenses, or <br />causes of action that mey ndse because ol instelletion and maintenence o} <br />the improvement ar other righbof-wey usa hereto applled lor end lunher egrees <br />to remove same upon notice fmm the City antl to raplece pu6lic propeAy <br />damaged Ihereby. � <br />WORK AUTHORIZED BY THIS PERMIT MUST 8E STARTED WITHIN 180 DAVS OF DATE PEPMIT IS ISSUED AND THEqEAFfEfi IS TO 8E DILIGENTLV PURSUED TO <br />COMPLETION. THIS PEFlMIT MAY BE CANCELI[D BV THE CITV UPON ANY STOPPAGE OF WORK ON THIS PROJ[CT OVER 90 DAVS Dl1FATI0N. <br />