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Date 7-18-91 a�oiicwo.wspermn. <br /> nma oeoi . 91/27358 <br /> Application For <br /> pUBL�� �dORKS PERMIT P�oe�wo�ksrce <br /> ra�.�F�e s <br /> les9 APP�Fee FeiC S - <br /> Balance0ae $ <br /> x r� Print or Type Only � � <br /> t7 C+7 <br /> ��H • <br /> I 9 Hcn Beiyl Butchcr 1508 Hovt Ave Everett 98201 252-7270 _ _ <br /> H �y� Owner MailingAddress CAy Z�P ����r��. <br /> y Y h-+ <br /> �C c] <br /> y 77 Owner -- <br /> ^'�" Mailin hddress Ci�y ZiP Phone <br /> .�i� p.i.�i� Applicant 9 <br /> (p H <br /> I y zrg <br />� ty O['�1 Describe Proposed work _Znd storv addition and interior remodel <br /> H C7 <br /> pH <br /> �r n o <br />� �V � W <br />� r H� �roject Atldrass(il known) 15D6 HOVt AVe - � � <br /> il C Cn , <br /> I O �� Fttach(our(4)copies of plans lor proposed work� Draw to scale and note the following as applicable: � <br /> qq a Property Lines • Cen�erline o�street � <br /> 3 [T7� • Outline and dimensions ol all eaisting and • Indicate North <br /> z y� proposetl structures on the lot • Show any pronosed graAm9 chanqrs <br /> y p y • Existinq and p�oposed utilities • Show measurements � <br /> DO �:OT WRITE BELOW THIS LINE � <br /> PERMIT CONDITIONS <br /> 1.All calls for inspection shall be matle 24 hrs.in advance-phone 259•8810. � <br /> 2.All work shall be pedormeC in accordance with Ihis permil and current City ol Everatt Design and Con,truction <br /> Standards and SpecificaFons. <br /> 3.Call Location Underground Service 4B hrs.betore you dig.TOLL FREE NUMBER 1•S00•424•5555. � <br /> � � <br /> y':� /�� .1 � <br /> 1 V G� i'lJ �( � f.. �V O✓ C-�S t--�1/wt, � � L Y�CC,>_ . <br /> � � <br /> � �-�,�,��_l/�� ` ��-- �'"' <br /> _ _ � 7_ � �; ��� � <br /> � � c� , cc.. ��- �� � <br /> c-�' i�i��r� ��. ��- � c <br /> � /� � <br /> _ . ' �' ) .�l r`��f�' � �1` � l- `�L (�c�✓a�l- �e.�j�J� C�'S . <br /> ACKhOWLEDGEMENT OF CONUITIONS <br /> _,. ihe undersi9ned owneciapplitant hereby agrees lo hold and save harm <br /> ` --- --------- ��----- - k��:s the Cit7 0l Everett �rom any and all claims lor damages, costs <br /> _._ —_—__.— - � <br /> ���.penses, or cause5 of aclio: �hat mny arise because of insiallation <br /> snd maintenance ot the impwvemen� or olher righ4oi�way use heretn , <br /> �,,, __ __ ___ nc�phed lor and lurther agrees lo remove same upon notice liom th�� <br /> � rtppir,vad foi Gonshucbon ���'�O Cdy and to replaco puUlic properly damaged ihereby, <br /> FINAL INSPECTION Date . <br /> l,pPr:•ved as Conslructed Signature ol Applicant Date <br /> WORK AUTNORIZE� BY THIS PERMIT MUST BE STARTED WITHIN <br /> �4g��� PUBLICWORKSDEPAaTMENT 1t30 DAVS OF DATE F'ERMIT IS ISSUED AND THEREAFTER IS TO <br /> 3200CedarS!ree! DE DILIGENTLY PURSUED TO COMPLETION.THIS PEPMIT MAY BE <br /> Everelt WA98201 CANCELLED 8�THE GTY UPON ANV 570PPAGE OF WORK ON THIS <br /> Phone-259-�B10 pqOJCCT nV[17 C�0 D�Y'S OURATION. <br /> ` _ —.____ . _ <br />