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8,/30/85 <br />Date <br />ApPlication For <br />PUBLlC WC)RKS PERMIT <br />P:int or Type Oniy <br />Harmon 6 Assoc P.O. Box 1179 Stanwood <br />Owner Mailinc lddres Ci1, <br />SamP <br />Applica�t <br />Describe Proposed Woik <br />Project Addrea, (il knowr� <br />Mailing Address <br />Tenant improvement <br />Zip <br />Fu01m Wmks Perm�it s J^ '�� � <br />eiae.ocnt. RS/15367 �- <br />Pu01¢ Warhs Fee <br />Tolal Fea � <br />Lass ApO� Fae Paid $ <br />Balancc Due $ ��� <br />�S!c��9 <br />98292 629-4536 <br />Phone <br />Attach four (4) copies of plans lor propcsed work - Draw to scale and note the following as applicable: <br />� Property Lines • Centerline of street <br />• Outline and di�ncnsions nf all existing and • Indicate North <br />proposed structures on the lot • Show any proposed grading ch2nyes <br />• Existing ano prnposed utilities • Show me�surements <br />PERMIT CONDITIONS <br />7. All calls for inspec!ion shall be made 24 hrs. in advance - phone 259-881 5. <br />2. All work shall be perinrmed in accordance with this permit and current City of Everett Design and Construction <br />Standards anA Specitications. <br />3. Call Location Underground Service 4B hrs. before you dig. TOLL FqEE NUMBER 1•$00•424•5555. <br />j �f�f'LiCliil,�i' _S//ACC %�.eC���iGJ� Yl !�C.-_�C'/-'r� , � <br />�.t'�_ r <br />�J✓Q�i✓��=.�� f�:.e' Ti/E �S%i;E"ET .%.;�.�,�c��.-'ti:;e�idi3 <br />aE��=„�E Ti/•s r'E-,� /�7�,— ;s �ssG�E-v, (i;,,�� yvr -'�.;I�o c� <br />.'J�-. A/�i�L.C�lN% /��JL'ST �f1G't` A./�i�it[/��EtJ �lLi1J�s" �� >/!r <br />SiTE� %��i•r-Lui�EinE��i !�(//T/!/.t/ /D Li.e f/_f f4�TE�' <br />T�S /�-i'in.! /S /_SSCc'&�. J <br />r�..-t n �D� ! x Sd-a.��r� <br />� A-�le� � � <br />� �/ � (,� u `�c e � P <br />ACKNOWLEDGEMENT OF CONDITIONS <br />S <br />/-�'�� <br />7ate <br />A d <br />I everet[ PUBLIC WORKS DEPAFTMEN � <br />i � 3200 Cedar Slreet <br />Evr�retl. WA 98?O7 <br />Phone:259-8815 <br />� <br />� <br />� <br />� <br />� <br />The undersigned owner/applicanl heieby ayrees �o hold and aave harm� <br />less ihe Citl' of Everett irom any end ali claims lor da:�eges, costs, <br />expanses, or causes ol aclicn that may arise 6ecause ol installation <br />and maintenance ol ihe improvement or other righFof-way use hereto <br />applied (or and further agrees to remove same upbn notice Irom ihe <br />City and eplace pi b!ic pwperty�maged thereby. <br />� t%�,� Fc/' <br />`, ��rL ' l� a j"%�-�'-ti,:�l % t�, ie%✓'0�(,� d.`f t*.'c <br />Si/ t re ot�l pPlicant � Date <br />WORK AU1I10RIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF UATE PERMIT IS SSUED AND THEREAf7ER IS TO <br />BE DI�IGENT�_Y PURSUED TO (;OMPLETION. THIS PERMIT MAY BE <br />CANCELI_ED BY THE GTY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OV[R 90 DAVS DURA710N. <br />