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Y q / <br /> Datcr 6-29-92 a�er�woiksP�,m�i. /02 Z7cri' <br /> App�ication For Bipq 0ep1 y 37190 <br /> PUBLIC WORKS PERI'�AIT PUEhcWorkSFeo <br /> Tolal Fee S <br /> Less FpOI Fee Paid � <br /> UO <br /> Balancc Duc $_ S�` <br /> Print or Type Only o�, <br /> `g o "'' ��'—�Y593/2B3/ <br /> `-'� � � 007—,3�25�0/GS3/ <br /> Pat & Pearl Nardone 505 244th SW Bothell WA 98021 776-6200 <br /> Owner Mailing Address City Zip Phone <br /> Baylis Brand Wagner 1750 112th Ave Nti Ste D-154 Bellevue 98004 454-0566 (Tom LambriQht) <br /> Applicant Mailing Address City Zip Phone <br /> 3-PcEx aif/, � <br /> Describe Proposed Work convetting duplex to parkinA spaces <br /> 304'/A .B C W <br /> Project Address�if known) 3041 Kromer Ave � � -� � � L <br /> r <br /> Attach lour 141 copies of plans lor proposed work- Draw lo scale and note ihe following as applicable: � �� � <br /> • Property Lines • Centerline of streel -� ♦A <br /> • Outline and dimensions o(all ezisting and • Indica�e Norih V� <br /> proposed sirucWres on ihe lo� • Show any proposed gradiny changes <br /> • Exis�ing and proposed utilities • Show measurements � <br /> DO NOT WRITE BELOW THIS LINE � � <br /> PERMITCONOITIONS ' � � O <br /> 1.All calls for inspection shall be�nade 24 hrs.in advance-phone 259•8810. � � <br /> 2,All work shall be perlormed in accordance with lhis permit and current City ot Everett Design and Construction <br /> Standards and Specitications. <br /> 3.Call Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1-800•424-5555. . - � <br /> Y', Sl t�C L(JO�.��2'0 �e �me /62�����.�- 2��ai/fnic� O <br /> �c� ��t.��i-ci LdU7�a- c�-2fi! . CnV b'''/O -`�2 �CpP(/ C1�aC�J . <br /> a / � <br /> �/ <br /> O <br /> � <br /> ACKNOWLF.DGEMENT OF CONDITIONS <br /> The undersigned ewner/applican[hereby agrees to hold and save harm� <br /> less the City of Everet� from any and all daims tor damages, costs. <br /> C-!'�//_ � //� expenses, or causes of action �hat maY arise because of installation <br /> � r � o 7 antl maintenance of the improvement or other right�ol-way use hereto <br /> Il/L� O� CS �� Z applied fot and turther agrees to remove same upon notice Irom ihe <br /> ApPreved lor Constructi ry - j.- �Date City an qieplace public property damaged �hereby. <br /> C � / <br /> . /_ � s <br /> �!�c��'��--<--- 3"`� 3 /3 - ,( y i.�9��t <br /> PINAL INSPECTION Date ` <br /> Approeed as Constructed S nature cf Applica t ��� ��a��' <br /> ' PUBLIC WORKSDEPARTMENT WORK AU�fHORIZED BY THIS PERMIT MUST 8E STARTED WITHIN <br /> 180 DAYS OF DATE PERMIT IS ISSUED AND THERtAFTER IS TO <br /> �� 3200CedarStreet BE DILIGENTLY PURSUFD TO COMPLETION. THIS PERMIT MAY BE <br /> �6fYrE7'r Everelt,WA98201 <br /> � Phone:259-8810 CANCELLED BY THE CITI'UPON ANY STOPPAGE OF WORK ON THIS <br /> PPOJECT OVER 90 DAYS DURATION. <br />