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� 3 � <br /> Date 3 ZS 91 " Pu�lic Works Permit� �/- /� <br /> .o Application For eiaopeo�.+31/26683 <br /> o- <br /> PUBLIC WORKS PERMIT PuElicWorksFee <br /> Toiai ree e <br /> ¢ — <br /> � /� Less ApPI.Fee PaiO $ <br /> � T POSTING � °° <br /> O O] t� O OJ .. {r Balance0ue $ �� — <br /> Print or Type Onl� o � � � �-+ <br /> � a `� � �, :� Oo z -_��zz- y��-n�n- ii -g�/ <br /> r•, w .» r, <br /> u- .a w <br /> Temple Beth OR m 321�I.ombard Everett 98201 259-6650 <br /> Owner °��- � � ��i�ng Address City Zip Phone <br /> m oco rro • ci <br /> O 40 .ZfnOi— l�.l <br /> \ o J J O fi :C <br /> Owner o am � maor� <br /> Applicant Mailing Address City Zip Phone <br /> Describe Proposed Work Partial demolition & new addition to existin9 temple <br /> - W <br /> Projecl Address(if known) 3215 Lombard � <br /> Attach four(4)copies of plans for proposed work- Draw lo scale and note the following as applicable: �� <br /> • Properry Lines • Centerline of slreet /� <br /> • Outline and dimensions of 211 existing and • Indicate Norih �� <br /> proposed structures on the lot • Show any proposed grading changes <br /> • Existing and proposed utilities • Show measuremenis � <br /> DO NOT WRITE BELOW THIS LINE <br /> PERMIT CONCITIONS O <br /> 1,All calls for inspection shall be made 24 hrs.in advance-phone 259•881 O. � <br /> 2.All work shall 6e peAormed in accordance with this permit and current City of Everett Design and Construction <br /> Standards and Specifications. <br /> cation Undr.rground Service 48 hrs.before you dig:TOLC�FREE-NUMBER-1_840•424•5555. � <br /> � r11��-� �'�G Ba�,•� (c� S��Pw�.c� #yo2) � O <br /> NI 9� �qP" (���j .�����-�'v�� � _.��, .�� � <br /> \ � �v rY�i�ir�v� a� (p �� �/ame Lt h �%/�.� � <br /> � -_.. ---�_ //� <br /> 5, f��.�fe. R^o�oo�r � n.->..�y .c��c�/Iv a rn.�n-c�,ucT� �� �♦ <br /> ./ � i � �/ <br /> v 3 c-L�a�- B n�Pl,«Q-� cz.�i �/ o�' -G'uaadc�' �'c�+� . <br /> � ai.c. Q.ru1 Stc�iu/n.(�/�✓ dQm�r<<� . L1.2�.-rt� CU��t«�Jnl , a <br /> G r� <br /> � � , Q.�Jl' tu�z�?� ,z` �i c o�nhe-�t- -Cc G`�c � ���it�' SSf4�t��2_ <br /> � .Q � ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees to hold and save harm� <br /> � � less lhe City ot EvereU from any and all claims for damages, costs, <br /> expenses, or causes of action that may arise beca�se of insta!lation <br /> � �✓ /> /J ,/,��_ � and maintenance of ihe improvement or other right-o4way use hereto <br /> /�JCOCj^ 7 applied tor and Nrther agrees to remove same upon notice irom the <br /> -' �or Con truction Date Ciry and to replace public property dam:3ed thereby. <br /> F� I , ECTION Date ����-"� a�� W"�'�— � J/g <br /> Ap prov e d a s C o n s t r u c l e d S i g n a t u r e o f A p p� n t � Date <br /> �A�I� PUBLICWORKSDEPARTMENT WORK AUTHORIZED 0Y THIS PERMIT MUST BE STARTED WITHIN <br /> 3200CedarSireet 180 DAYS OF DATE PERMIT IS ISSUFD AND THEREAFTER IS TO <br /> Everett,WA 98207 9E DILIGENTLl' PURSUED TO COMPLETION. THIS PERMIT MAY F <br /> Phone:259�8810 CANCELLED BY THE GITY UPON ANY STOPPAGE OF WORK ON T <br /> PFOJECT OVER 90 DAYS DURATION. <br />