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qpp5cation Por <br />PUBLIC W(�RKS PERMIT <br />PUBLIC WORKS DEPARTMENT <br />3200 Gedar Sireel <br />Everett, WA 98201 259-8810 <br />TYPc OR PRINT ONLY <br />Gary Jellison PO Box 6241 <br />Owner Mailing Address <br />Owner <br />Cnnlir:ant Mailing Address <br />Describe Preposed Work <br />new hetzse� <br />PROJECT ADDRESS (if known) <br />��? P�SiING <br />,, / <br />� <br />2-4-97 <br />Date _— — <br />Public Works Permil N _���0 � <br />Building Permit N ��"' <br />OCT Q 6 99�% /f(� _- <br />ublic Works Fee S �`� — <br />Wa 98036 210-589� <br />City <br />City <br />-841� <br />�hone <br />Phone <br />—7— 04/O1/9± 5=27FM <br />Attach four (41 copies o1 plans for proposed work - Draw to s9�le and n�ole the tollowing if applicabla. 9 P��Y`� <br />•Property Lines `Outline and dimensions ot all exislin and pm osed strucWres on the lot Existin and N' ies <br />•Genterline of street •Indicate North 'Show any pmposed grading changes •Show measuremeniseL� 39��-00 <br />w <br />' DO NOT WRITE BELOw I Fiis urv❑ �CH �120.00 <br />PERMIT CONDITIONS: SkCFIRG 34.50 <br />1. All calls for inspection shall be made 24 hours in advance - phone 259-8810. ��„ ..,n <br />2. Atl work shall be performed in accordance with this permit and current City of ��V H DesY�78�� <br />Construction Standards and Specifications. ^ <br />3. Call Location Underground Service 48 hrs. beTore you dig. TOLL FREE NUM ���9��bE1?O.�p55. <br />k00D3 34 <br />�� (�i►'Y,C,-� ►r'oo-F -b� f�vto� -i-a � �5,,� ��;oo <br />f.HECf: 33�93e 75 <br />S o� 5r dG o-� � o�- <br />5• <br />�'� �� ;�, ���,�,-I-s �5 � <br />�. ��� p � d�.�� �/� /�-� <br />i��lz�r� <br />ACKNOWLEOGEMENT OF CONDITIONS <br />The undcrsigned ov+nedapplicaN hereby agrees to hold and s�ve iiarmless <br />the City of Everelt Irom any and all claims tor damages, costs, expenses, or <br />causes of mdion that may arise because of installation and maintenance o( <br />the improvement or other right-of-way use hereto applied tor and fueher agrees <br />to remove same upon notice f�m lhe Ciry and lo replace public property <br />damaged thereby. <br />� � <br />� / / <br />/�i%`. ��j r���� �^ <br />�✓ �, �Dte - <br />Signature o <br />COMP � p ORIN SDPL"RMITS AY BE CANCEL� ED BY TH�E CITI' UPON ANY SOTOPPAGE OF WI OHK ON THIS FROJEC OVER 9� DAYS �I NIRATEONLV PU55UE� TO <br />W <br />� <br />�/� <br />V♦ <br />V♦ <br />� <br />a <br />