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IYPE OR PRINT ONLY <br />Appf��cation Por <br />PUBLIC WORKS PERMIT <br />PUBLIC WORKS DEPARTMENT <br />3200 Cedar Sireet <br />Everett, WA98201 259-8870 <br />� ;'hSTING ocr_ <br />2-10-97 // <br />Date — <br />Public Works Permit # 1 / _/`� `� _. <br />Building Permit # 54180 <br />Public Works Fee 5 �^�' _ <br />Gary Jellison 1132 179th St SW Lynnwood 98037 210-5893 <br />Owner Mailing H�dress City Zip Phone <br />Owner <br />Applicant Mailing Address City Zip Phone r� <br />Describe F'r000sed Work new <br />PROJECT ADDRESS (if known) 2�8 �" <br />04/Ol/97 5:35FM <br />N00054180 <br />PIEG S34.00 <br />Attach four (4) �opies of plans for �roposed work - Draw to scale acd �ote the tollowing if applicable: SF.CHRG 44. SD <br />•Property Lines •Outline and dimensions of all existing and proposed stmcWres on th? bt 'Existing and pr�f�tilitie5y�0.Q0 <br />•Centedine of sireet •Indicate North •Show any proposed grading changes •Show m=zsurements �0��9Z�Z <br />THIS LINE �}00031�'b <br />PERMITCONDITIONS: SEWER 370.GD <br />1. All calls for inspection shall be made 24 hours in advance - phore 259-8810. S5'SDFV 4�296oG <br />2. All work shall be performed in accordsnce with this permit and current City of �r�tt Dq�L�;q.�n� <br />Construction Standards and Specifications. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-B00-424-5555. <br />G� <br />�- <br />� <br />T� y h-f - l� e ✓�-�-o�, rvh o-Ff %a s-(ww� �� �� <br />��. <br />��►-�u� ���►���s �S �� �y�� ;,��s <br />��►�v� �l� c��� ��I �n� <br />�v�osi t� C� -}�-n I� s d: r��t�:d �� P� � l;z w-f�ty <br />, n s ��cs+a,r; <br />W <br />t: �:: <br />� <br />��^ <br />V♦ <br />iY <br />0 <br />� <br />Iu <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undersigned owner/applicant herehy agrees lo hold and save harmless <br />ihe Ciry of Everztt from any and all claims for damages, costs, ezpenses, or <br />causes of action that may arise bec�use of installation and maintenance of <br />the improvement or other right-of-way use hereto applietl for and further agrees <br />to remove same upon notice from the Ciy and to replace public propeny <br />damaged thereby. / / �� <br />.� �' i <br />:" <br />� �=: = y �--; <br />Signature of Appllc ' ` / a� <br />c'�, <br />WCRIC AUUHOR2ED BY THIS PERMIT MUST BE STARTED WITHIN 180 DAYS OF DATE PEFMIT IS ISSUED AND THEREP.FfER ISTO 6E DIUGFNTLY PURSUED TO <br />COMPLETION. THIS PERMIT PdAY BE CANCELLED Bl' THE CIN UPON ANY STUPPAGE OF WOAK ON THIS PROJECT OVER 90 �AVS DURATION. <br />F'y <br />