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.. <br />Date �-- <br />Applicat(on For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />Owner <br />APP��cant <br />Uescribe Propoeed Work . <br />ProJect AOdross (if known) <br />Plan Ch�ek Nos <br />1�pp11cat.Date: <br />Job 11ddr���: <br />Own�rt <br />Tenant: <br />D ic�ofdi►orke <br />REPL11C8 GAW168 <br />B 4384� <br />03/22 94 <br />2446 ISON ST <br />P'OSHSIlt OENg <br />G71R71CS/SFR <br />SEpA <br />OtFICE SET JOB 86T <br />11PPROVSD !OR PERitITs DATE_���_ By <br />wac won. r.�n . <br />S4V. D�M � _ <br />WOht Wonu FN <br />Tet�l FN i <br />L�u AppL FN P�k i��� <br />M�nn ow { <br />t�p Phons <br />Z'P PhonB <br />Attach four (q) eopfa� oi pl�na fo� propoaed work • Oraw to ecele anE note the fotlowinp as applicable: <br />• Prop�rty Linea • Cenlerline of atreet <br />• Outlina �nd dimensions ol all exislinq anE • Indicate North <br />propoqd atrueturot on the lot � Show any proposed pradinp chanpea <br />• Extatinp anE proposed utllities • Show me�surements <br />PERMIT CONDITIONS <br />1. All utl� tor InapKyion ah�ll bs m�de 24 hrs. In advence • phone 259$810. <br />2. All work �hdl be peAprmed �� accoMence with this permft and curront Ciry of Everett Desipn and Conatruction <br />St�ntlardt �nd SpaciHutiont <br />3. Cail I.oc�tlon Underpround 3ervke q8 hra, before you dip. TOLL FREE NUMBER 1•800�4Q4•5555. <br />�U�LIp Wo111t• �ERMIT <br />NOT_ QEOUIRED <br />BV�� <br />DATE Z S� <br />ApprovaC for Conetruction Date <br />FINAL INSPECTION Date <br />Approved es ConstrucleA <br />PUBLIC WORKS OEPARTMENT <br />3200 Ceaar Stroel <br />EverotL WA 98201 <br />Phone:259•8870 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />W <br />� <br />� <br />� <br />� <br />O <br />� <br />� <br />O <br />a <br />The undersipnetl owner/applicenl hereby aprees to hold en0 save harm• <br />less Ihe City ol Everell Irom eny and all claime for damapen, coats, <br />expenses, or causes ol ectian that msy ari�e because of tnst�llation <br />and maintenence of Ihe improvement or other riqht•ol•way uae hereto <br />aoplied lor and further �preea to remove ume upon notice (rom t�e <br />City and to replace pubtic property demaped thereby. <br />Signalure ol Applicent Date <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITMIN <br />1B0 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CPNCELLED BY THE CITY UPON ANY STOPpAOE OF WORK ON THIS <br />PROJFCT OVER 90 DAVS DURATION. <br />