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�B�Q�^.�C�� PuOim Won�Permn• <br /> Application For BiOp D�pl • 37517 <br /> PUBLIC WORiCS PERMIT P°°��W°�•,-F�.- - <br /> .o�.�F.. � <br /> las!�OD� fee P��E s <br /> Print or Type Only a,�.��.o�� s <br /> C D 6 Jovice Bovev 9619 Baker nr F.VPTAtf ap�na 355-1977 <br /> Owner Mailing Add�ess City Zlp Phone <br /> Owner <br /> Applicant Meiling Atldress City Zip Phone <br /> DeeC�ibe P/OpOSed WO�k _�[]�J�tinn ramndol ic ra—rnnP h0 $SR <br /> W <br /> Pro�ect Addresa�il known) 4619 Baker Dr. � <br /> Atlech lour(4)copies of plena Im proposed work• Drew lo scale end note the followinp as applicable: � <br /> • Property Linee • Centerline ol sl�eel � <br /> • Oulline end dimensions of all exieting and • Indicate Norih <br /> proposed atructurea on the lot • Show eny proposed grading chenges <br /> • Exislinp end propoaed utilities • Show meesuramente � <br /> 00 NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> t.All cells lor Inepectlon ahall be mede 24 hra.In advance•phone 259-8810. � <br /> 2.All work ehetl be peAormed In actordence with Ihie permlt end current City of Everetl Desipn end Con8lruction <br /> Standarda and Speclflcatlone. <br /> 3.Cell Locatlon Underpround Service 4B hre.before you dip.TOLL FREE NUMBER 1•800-424•55b5. � <br /> � O <br /> �d� �L'C�Z/n—�,.�+..-r /��`��c,c<.ar-� ,_,/ii� � <br /> �� <br /> 7 -z�- � z (� <br /> � <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> Tha undersipned owner/applicanl hereby egrees to hold and sava harm• <br /> — less the Cily ol Everett fiom e,ny end all claims lor Eameges, costs, <br /> expenses, or causes oi ection ihat may edse beceuse of installation <br /> and maintenence of the improvemenl or other riph�•oi-way uae hereto <br /> aNplied lor and furlher aprees to remove seme upon nqtice Irom the <br /> Apnroved lor Conslruction Oate City and to replece public properry damepetl ihereby. <br /> FINAL INSPECTION Date <br /> App�ovetl ae Conshuclad Slgnafure of Applicant Dale <br /> � PUBLICWORK90EPARTMENT WORK AUTHURIZED BV THIS PERMIT MU:T 8E STARTED WITHIN <br /> 3200CedarStreet 180 DAVS OF DA7E PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everett,WA98201 BE DILIGENTLY PURSUED TO COMPLETION. iHIS PEFiM17 MAY BE <br /> Phone:259•BB10 CANCELLED BY THE CITY UPON ANV STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAVS DURATION. <br /> 1 <br /> �— - <br />