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Det6 4 29 93 weKwemr.�mu. �'13 9 / <br /> Ap0litelion For eao o•o�• <04 9 <br /> PUBLIC WORKS PERMIT a04WeMfw <br /> ta.ih� s <br /> L��i�wl fn o�q 3 <br /> Print or Type Only <br /> e.i.M.o�. 3 �� <br /> 3teve Hallard 1609 oakes Ave Everett Wa 98201 259-8069 <br /> Owner MeII1nBA�eress Ciry Zip P�one <br /> PaciFic G�raaes 259-1311 <br /> Applicanl MeilinqACtlre59 City Zip P�one <br /> DelcliEe Propo9ed Work NeW gaiage <br /> W <br /> Piolect Adtlreas(il known) � <br /> Altet�lour(4)Capies oi plans lor proposed work•Draw�o Scale end nate the lallowing as appli[able: � <br /> •Propa�ry Lines •Cenletline ol sbael /A <br /> •Outline entl dimensions ol ell eaisting antl •Indicate Nort� v� <br /> pmposed stmctures on t�e lot •S�ow any proposetl gratlinq c�anBes <br /> • Existing and oroposed utililies •S�ow measurements � <br /> DO NOT WRITE BELOW TMIS LINE O <br /> PERMIT CONDITIONS <br /> 1.All cells lor Inspection shell be made 24 hrs.in ativance•phone 259�8810. � <br /> 2.All work shell 6e OeAo�med in eccordance wit�thi9 permll end curtent City ol Evarett Design and Conslruction <br /> Standards and Spxillca�lons. <br /> 3.CeIlLocationUntlerground5ervice48hs.�eloreyoutlip.TOLLFREENUMBEfl1•$0C1�424-5$55. � <br /> �F. Drtv-v..,� a�rroa�:+� ��r,�l cwi��t � �rby std � 308. <br /> � <br /> � <br /> � <br /> � <br /> a <br /> ACKNOWLEOGEIAENT OF CONDITIONS <br /> The undersipnetl owner/aOPlitant here0y oB�ees lo holJ antl seve�erm� <br /> less Ine Cily ol Everetl Irom any antl all claima lor tlamage; cost4 <br /> e.pense& or causes ol aclian Ihet may orise because ol installation <br /> `r � � entl mainlenanca ol I�e improvemenl or ol�er ripht�ol�wny usa herelo <br /> applicd lor entl lu�ther agrees to remove snma upon nolice Irom Ihe <br /> A oveE or Co mction! �.., ate Ciiy and�0 leplace puhlic propatly damaBed Ihereby. <br /> �l �.� - - il_�.-r� <br /> FINAL INSPECTION ` Date <br /> AOProvetl es Conslrucletl Si9naWre ol ApPlicanl Date <br /> PUBLIC WORKSDEPAqTMENT h'ORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> 3200CeJar5lreet 180 DAYS OF DATE PERMIT IS ISSUEO ANO THEREAFTEq IS TO <br /> Evemq WA 9B401 BE OILIGEHiLV PURSUED TO COMPLETION.7HI5 PEPMIT MAV BE <br /> Phone:259�BB10 CANCELLED BY TME CITY UPON ANV STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAVS OURATION. <br />