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Date lO�ZS�JS Pu�LcYlo�FSP?m:�. `I J f SJ�y / <br /> Applica�ien For , 6�aq oeo�.• 49874 <br /> N <br /> PUBLIC WORKS PERI� IT F°°°°W°�°s°�E <br /> TotalFpe 5 <br /> G Less 4opl Fee Paip �i <br /> J� /���� � O� ^�J O N O � p �. Balnnce Ouc $�_ <br /> Print or T e Onl n If �� � — <br /> yP y �, ; ; �STING �� r � � o � o � .� � <br /> e-i P Ir� M W CJ K- K� O <br /> ��'� 1N' N M d ��� <br /> Cy �, 'A r, W T��. <br /> William C Hayes PO Box 3561 Everet�, WA�8203 252-29�6 <br /> Owner Nlaiiinn �cdress � � Cny �; " ti r'� �C�te Phone <br /> rri ococ� xz � o t� <br /> 0 oc� m � c� �–' :� ou5w <br /> � OJ J LLIfr: 4_' J O x <br /> OWTl2I .�+ 3C p� fi S_ UJ O G. 5: UJ L� <br /> .-I <br /> Applieant PA��JinqAddress Citv –� Zin PhonP ----� <br /> Describe Proposed Work garage �a/apt above ____________ _ _ <br /> —_ ..—— _—___--�_- --_-- � i <br /> Project Address�11 knowN 3119 Lombard AVe (C) ___ __ .__ _ � <br /> Atlach tour(4) copies ol plans loi proposed wo�k � Drav: to ac,�l��ann ncJe �h��following as apUlicah�e: � <br /> • Property Lines • Genterline of street ♦^ <br /> f Outline and dimensions of all ezisting anA • Indicate Norih V� <br /> proposed strccWres on the lot • Shov:any proposed 9ratling r.tanges <br /> • Existing and proposed uti6ties • Show mr,asurements � <br /> �� <br /> DO NOT WRITE 6ELOW THIS LINE O <br /> PERMIT�ONDITIONS <br /> 1.All call;for in:pection shall be matle 24 hrs.in advance•phone 259-8810. � <br /> 2.All work shall be performed in accordance with this permit and current City of Everett Design and Construction <br /> Standards and�?ecifications. <br /> 3.Call Locat�on Undi�rground Service 48 hrs.before you dig.TOLL FREE NUMBER 1-800•424•5555. � <br /> � , ��do�uvf,s� �or -�► � s �p�-�j sh��I �e �t�5°z"!� O <br /> -� � ',' pv� — ;-� r.� ►--��s ����� n� ��� �,— <br /> mru-���;� � s h��I �2e� U.�'c . (n <br /> 5 , �pn,-�� ,i2o c.�-F ,[���s�r -fa s Gd�se�r a <br /> � ACKNOWLEDGEP.IENT OF CONDITIOMS <br /> The undersiqnecl owner/applicant hereby agrees to hold and save harm- <br /> � � loss the Gry of [veretl irom any �nd all claims for damages. custs. <br /> //��� i expenses. o� causes of ac�ion ihat ma/ ans= because ol ins�allation <br /> /�/�� �, �nd maritenance o! the improvement or other nght-ol-way use here�o <br /> �i«��. applirC for and furiher agrees to remove same upon notice irom ihe <br /> Approved for C ructio� Date � �,�y,�i;�� �� i��placa pubhc proner'�• damaged thereby. <br /> � I <br /> �-L y'l�l _ I rl� � � <br /> FINAL INSPECTION Date I 6 — <br /> Approved as Construc�ed I Siqnalure of ApPlican! Date <br /> /Ar�ia� PUBLICWORKSDEPARTMENT I LVORK AUTHORIZED BY THIS PERMIT UST BE STARTED WITHIN <br /> 190 DAYS GF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200CedarStreet I pE DILIGENTLY PURSUED TO COMPLETION. THIS PEHMIT MAY BE <br /> EverelL WA 98201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> P hone:2 5 9-8 8 1 0 j PROJECT OVER 90 DAYS DURATION. <br />