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�8t8 �\ � <br /> Pu01ic Worlu P�rmN• <br /> APPlfcation For eiea ow�. <br /> PUBLIC WORKS PERMIT �aKW��F� <br /> Ta.i Fn t <br /> l�u�ppl FM P�IC � <br /> Print or Type Only e.u�.ow s <br /> Plen Chack No: B 35412 SBp11 <br /> Appllcat.Dat�s O1/21�92 <br /> Job addre��: 21Y3 W1ltD 1►VS <br /> Own�rs DONALDSON LJ►YTON <br /> Owner Tenants Zip Phone <br /> Propoeed Ueet SINGLE F1IMILY RBSIDSNCB <br /> Deec. of Workt <br /> ADD FOUNDATION <br /> APP��nt ZIP Phone <br /> OFFICB S8T JOB 86T <br /> Describe Proposed }►PPROVSD FOR PBRMIT: DATE_/_/_ BY <br /> W <br /> Pro�ect Addrees(if known) � <br /> Attach four(4)copiei of p��ns}or proponetl work•Draw to ecale end note the tollowinq es appliceble: � <br /> • Property Lines • Centedtne ol atreet � <br /> •Outline�nd d�membns of all eziatinp end • Indicate North <br /> propoaad structuros on the lot . • Show any propoaed pradlnp chanpea <br /> � ExltHnp and propwed utilftlee • Show measwements <br /> D N T WqITE BEL Y.�TMIS LINE � <br /> PERMIT CONDITIONS O <br /> 1.All plle for ImpecWon�hell ba m�de 21 hn.in�dv�nce•phone 25�-8810. <br /> 2.All work ah�ll bs psAortned in eccordance wiM thls pennit�nd curtent Ciy of Ewrett Deslpn�nd Conatiuction ' <br /> StuM�M��nd 9pecHic�tio�a <br /> 3.GII Loc�tlon Undsrpround 3arvice�8 hrs.beforo you dip.TOLL FREE NUM6Eq 1-800�424-56b5. � <br /> � O <br /> ��f.�� Gc�ozlh�c.N-u-�/ie t' r��zuu� I'z�"�� � <br /> ; �R N <br /> � <br /> a <br /> ACK�OWLEDGEMENT OF CONDITIONS <br /> The undersipneA owneUapplicant hareby epreea to hold end save harm- <br /> leas the City ol Everett from eny �nd all claime for demepea, costq <br /> � ezpenaes, or causea of action that may ariae beceuse of Installetion <br /> and meinlenance of the improvement or other ripht•of•wey uae heroto <br /> applied for and further aprees to remove same upon notice trom the <br /> Approved for Constructlon Date City and to replece public Droperty dama0ed thereby. <br /> FINAL INSPECTION Dete <br /> Approved�a Conntructed Signature ot Applicant Date <br /> � PUBLIC WORK.^,DEPARTMENT WORK AUTHOfiIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> 3200CederStraet 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everctt WA 98207 BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Phone:259•BB70 CANCELLED BY THE CITY UPON ANV STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAYS DUFATION. <br />