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Applitation For Date <br /> .��n� a4 /999 ' <br /> � PUBLIC WORKS PEf�MiT publicWorksPermitk 9�- <br /> PUBLIC WORKS DEPARTMENT <br /> 3200 Cedar Street <br /> Everett,WA 98201 (425)257•8810 Ouilding Permit k <br /> TYPE OR PRINT ONLY jU P OSTI N G MAR 2 7 2600 public Works Fee$ _�✓�� <br /> �i r,•�1- P�bl�a Se{�oely 473o Co/6� ��er�' `teaol 388 - 4-730 <br /> Owner Mailing Address City 2ip Phone <br /> GNJA Arch�fee� 272Z Co16.1 #G07� Everaf'f 9a�n{ 259 - ISGD_ <br /> Appllcant Maihng Ad ress City 2ip Phone <br /> Describe Proposed Work N��✓ S I�G(.���� �� �VG�G-ff Memo�i.�� � <br /> ���ym fo O✓l�G A, I' �G — fGG QCGE I ,�� H <br /> -Fh b�k�n� �of fo -�ftiG �o-�b.��� G�ran�sfsn • V♦ <br /> PROJECTADDRESS (iiknown) .3900 BrORI�W��/ � <br /> O <br /> Attach four(4)copies plans lor proposed work•Draw lo scale and note the following if applicable: � <br /> •Property Lines •Outlino and dimenslons ot all ezisting and proposed sWdures on the iot •Existing and nrcposed u�ilities <br /> •Centeoine ot street •Indicate North •Show any propo�eu g�ading changes •Show measurements � <br /> DO NOT VVRITE BELOW THIS LINE <br /> PERMIT CONDITIONS: O <br /> 1. All call,tor inspection shall be made 24 hours in advance • phone (425) 257-8810 <br /> 2. All work shall be periormed in accordance with this permit and current City of Everett Design and � <br /> Cons;ruction Standards and Specitications.. � <br /> 3. Call Location Underground Serv-^e 48 hrs. belore you dig. TOLL FREE NUMBER 1-800•424-5555. <br /> 7,� !(/vr,� fr� Be o�vi�c fkr f�lan o�k�� 7- /-�9 Gop,�`�� � <br /> �. � , : a <br /> �.. c`.,,, <br /> , ,� �l `� 199g <br /> ✓<�. �eP Gi�f/ Sf,^ce s ele�n af alC 2d�ineso�:. �C, <br /> �� ; ..; <br /> �a • T�j%s ��^mrf �ct �{or -�he ��Qin�e fonnec�.o/� ��t.t2'/;:�<'� <br /> r'. <br /> !yl o n r��s•r�;�� oF�fie /�v6li c Sfi�e-f� �o r c��rn�.���<►?h o� <br /> CL�4r�lineSJ'. ��� �e Ou�ners respo�c;��l�fc/ 't� It�sur�e <br /> �ha� -fhe p�r�les�ri4h �'✓a«k�'c,+ !.f ConSf�v���/ Co�rcC�L� . <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> ' Tho undersigned owner/applicant hereby agrees to hold and save hartn�ess <br /> 7 � the Ciry of Everetl trcm any and all claims tor damages,costs,eKpenses,or <br /> — causes of action that may arise because ol installauon and maintenance�t the <br /> prove on ru� improvemenl or other right-o1•way use hereto applied lor and further agrecs to <br /> remove same upon notice from tho City and to replace p c properry dam• <br /> � � -- _ <br /> ' _l% � � -- :-- �l!- �� aged thereby. p I <br /> FINALINSPECTION Date �j� �'��—/ j <br /> Approved as Conslructed �-�o o pp ican � a e <br /> WORK AUT110R�D BY TtiIS PERMR MUST BE STARTED NAIHIN 180 DAYS UF DATE PERMR IS ISSUED PND THEREAFIER IS TO BE DILIGENTLY PURSUED 70 <br /> pp�dplFilON.TNIS PERWR MAY BE CANCELLED BY THE GN UPON ANY STOPF'AGE OF WORK OF171iIS PROJECT OVER 9D DAYS W RATKNd. <br /> �_ <br />