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� r.�' <br />Datu �une 17, 1993 <br />w <br />PUBLIC <br />Print or Type Only <br />Applicatim� F� <br />WOF�CV <br />� <br />� <br />w <br />� <br />Houaing AuthoHty of the <br />CNJJ Architects <br />Shsa� A-8 <br />PERMIT <br />I� V�.] [� .IfI n � <br />W M � M � x� <br />M A _. M <br />O]�' d5 3�Yt�}S 61. <br />Avenue, $607 <br />�_I public Warks Pe�mit • � J � <br />eieo.oea�.. � <br />I PuDlic Works Fee <br />Talal Fee S <br />I� VI f� 41 '�•,�•,• FS a.i <br />y� �} .6i�tencs�ue . S �.� � <br />�N mM 07 M �M y» g�I <br />.-t .�a �-+ <br />W ��A �t� aN <br />� <br />�r ec�r +, uW 8c2� '+PJ,� 2c�2 x <br />��i OJ u'S g�'L� GJ JC" �i pJ . <br />0� UIQI �� 617tia�fO 4l W yLp]Gl <br />Applicant Mailing Atltlress Gity Zip Phone <br />Miscellaneous site improvements to provide for handicap accessibility, includtng: <br />Describe Proposed Work <br />Damaged sidewalk re�laeement cu�b rwmn� ��kt..g .e-atrf�ing and signss <br />naw s(dewalks, ramps wlth handrails, and new aceessible entrances. � <br />Aiso included: New Pla <br />P�olect Address (il known� <br />• Attach lour (4) capies of plans lor proposed work • Driw to scate and note the following as applicable: <br />� • Property Lines � Centerline of street <br />� • Outlir,a and dimensions of all existing and • Indicatz North <br />proposetl structures onthelot � Show any proposed gradin9 changes <br />� � Existing and proposed utilities � Show measurements <br />W <br />� <br />� <br />� <br />PERMIT CONDITIONS O <br />' 1. All calis tor inspection shall be made 24 hrs. in advance - phone 259-8810. � <br />2. All work shall be performed in accordance wilh this permit and current City af Everett Design and Constructlon <br />StendaWs end Specificatlons. <br />3. Call Location Undarground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800•424-5555. � <br />S� t�� �!'�,�. �o•,o�x,� �� Pudl'.� wu:�a- a�-� 7-�9-7.3 �� a�,f� O <br />� �"1 13 � �l`Mi 1" J'� iW � �l/N�SJ' <br />� GO (,dCU,,�" <br />FINAL INSPECTION Date <br />Approved as Constructed <br />��r�PUBLIC WORKS DEPARTMENT <br />3200 Cedar Street <br />Everelt, WA 98201 <br />Phone:259-8810 „�., <br />� <br />� <br />O <br />a <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undersigned owner/applicant hereby agrees to hold and save harm- <br />less the City ot Everett Irom any and all claims for damages, costs, <br />expenses, or causes of action that may arise because of instailation <br />and maintanance of the improvement or other right-oi•way use hereto <br />�applied for and further agrees to remove same upon notice Irom ihe <br />City and to replace public property damaged tliereby. <br />� <br />Signature ol ' n Dale <br />WORK AUTHORIZED Y THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />