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TYPE OR PRINT ONLY <br />Owner <br />Y '� - <br />qppli<ation For <br />PUBLIC WORKS PERMIT <br />PURLIC WORKS DEPARTMENT <br />3200 Cedar Strzet <br />Everetl, WA 98201 259-8870 <br />Gary Jellison <br />�,� ����1�1`I� <br />1132 178th St SW <br />Mailing Address <br />Ownex <br />Applicant Mailing Address <br />Describe Proposed Work new house <br />PROJECT ADDRESS (if known) <br />�CT � b 1997 <br />/ <br />: <br />Date_ 2-10-97 _ <br />Public Works Permit # _ �f I �� <br />Building Permit N 54181 <br />Public Works Fee 5 �i� <br />98037 210-5893 <br />ry Z�P <br />Flione <br />Phone <br />ELpG 3701.?0 <br />Attach four (a) copies of plans tor proposed work - Draw to scsle and note ihe tollowing if applicabie: p`f; 8� �� <br />•Property Lines 'Outline and dimensions of all ezisting and proposed stmciures on the lot •Existing and pfop�5'ed utilitie� <br />t1ECH 260.00 <br />•Centedine of sireet •Indicate Norfh •Show any proposed grading changes 'Show measurements �CNFG ±4. SD <br />Uv rvv i vvni i � ���.... ����..._•� •— �0�0093?� <br />PERMIT CONDITIONS: WRTEF: $lO5.Q0 <br />1. All calls for inspection shall be made 24 hours in advance - phone 259-8910. <br />2. All work shall be performed in accordance with this permit ancl cu; rent City of EO�fA�tl�ign and <br />Construction Standards and Specifications. SEWEF. �'70.00 <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUM C�8�8Q% 344�i9955. <br />4, '(i t�� lrne r���, ����r�c run�� -f� �r�, drul� <br />�• <br />� <br />�1�. <br />�Y�rt-%G�G i ►��►'aVG �t e�� Zi5 �i►' � � l2 ►�/t�►r�s <br />2y�m� P ��i.v� dz, �� �%�l ��17 <br />C'i :�`C�SI GY1 �('!H �} "�� 2C S p r��.iL� �7 � � ��� �%01/�S <br />1�,���r. <br />�L <br />V♦ <br />Q <br />� <br />ACKNOWLEDGEM[NT OF CONDITIONS <br />The undersir.•^d ownedapplicaM hereby agrees to hold and save harmiess <br />the City of E� �-tt fmm any and all claims tor damages, costs, expenses, or <br />causes ot aci�on that may arise because ot installation and maintenance of <br />the improvement or other right-of-way use hereto appliad for and further agrees <br />to remove same upon notice from the City and to repL�ce public property <br />damaged tY�ereby. / <br />% <br />i <br />./�/%s, <br />� '��:i ��j / Da(e <br />SignaWre ot Appfic5il�l.� <br />COIdPlET10N.�T.IH 5 P[RMIT MAY BE CANCEL ED BYTH�E CITl'll!PON ANVSSTOPFnGE O'WORK ON THIS PROJECT 0 ER 90 0 YS DUR TEONLY PURSUED TO <br />