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Date '-10-95 <br />APplication For <br />PUBL.IC WORKS PERMIT <br />Print or Type Only <br />WD Tackitt 5917 Evergrei <br />Owner Ma <br />Owner <br />APPlicenf Me <br />Desc�ibe Proposetl Work _ eddition <br />Project Adtlress (il known� IO�OeaWeV <br />PupLc Worw� Parmit � <br />Bitlp Dapl • 4%]�9 <br />PuEirc WorMs Fee <br />Tai�i Fae { _ <br />Leu �oGl iee P��a a <br />8����ro Uua S <br />"P Phone <br />Allach four (4) coplea ol plens for prpposetl work - Draw tp scale and nole Ihe Iollpw{ng e. <br />• Property Lines <br />• Outline entl dimanaions ol ell exisimg and � Centerline ol sireel <br />proposetl structures on Ih i lot ��^dicale North <br />• Existinp and proposed utilities � Show eny •�roposed grading changeg <br />• Show measuramenis <br />PERMIT CONDITIONS <br />1. All cells for Inepection ehall be made 24 h�e. In advence • phone 259•8810. <br />2. All wo�k ehall be performed In eccordenca with this permit end curranl Cify of Eve�ett Design and Conetructlon <br />Stendards and Specllicetione. <br />3. Call Lxetlon Underground Service 4B hrs. before you tlig. TOLL FREE NUMBER 1-800�424•5565. <br />i'UBLIC WOqKS PEF.MIt <br />�r REOUIqEP <br />�Y �: <br />tDATE_ ' : c. �, <br />, —���._ <br />ApProved f�x Construclio—�-- <br />Date <br />FINAL INSPFCTION <br />F,pprovr.tl as Consiruc�etl Date <br />� PUBLIC WORKS DEPAqTMENT <br />3200 Cedar Street <br />Everett. WA 98201 <br />Phone:259-8810 <br />W <br />� <br />� <br />� <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undersigned owner/applicant hereby agrees lo hold antl save harm� <br />less �he Cily ol Eve�et� Irom any enA all claims for dameges. cosls. <br />eKpenses, or cau5es of aclion ihel mF.y eriae because ol installetion <br />end mamtenence ol the improvement or uther righhof�wAy usp herrlo <br />applied fo� and lurther ag�ees to rr.move sume uuon notice �rom Ihe <br />Cily and lo replace pubhc properly Jamaged thereby. <br />Signature of Apnlicanl — <br />WORK AUTHURI2ED BY THIS PERMIT M'JST BF STARTED WI7HIN <br />180 DAYS OF DATF PERMiT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAV BE <br />CANCELLED BV THE CIiV UPON ANY STOPpqGE OF WORK ON iHIS <br />PHOJCCT OVER g0 DAYg DURATION. <br />