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r ' i <br /> Date 2-6-92 PuOL<1Ya�Mf Pe�mit• <br /> e�ac.oea�..�355R 1 <br /> i, <br /> Applicalion For ' <br /> yr� PUBLIC WORiCS PERMIT °°°ro,.F:�"° S ' . <br /> �;y TO POSTING leeaAooiFeeGa�ES <br /> �D'.il'S. eaia„oeouo S <br /> y y y Print or Type Only <br /> Ha� f <br /> H Z H 258-4679 i <br /> � H� <br /> MARVIN S. JODOCK 2309 OAKES AVE EVGRETT 98201 � <br /> � �,x„�� Owner Mai{ing Addre55 Gity 2ip Phone i <br /> V1 H <br /> � z� ownex <br /> �.Qj. ty App��canl hlailir.g Atldress �'�Y Zip Pho°z I <br /> OH <br /> ��� Describe Praposed Work ADD\ TO SPR;180 SF <br /> zH� — <br /> � yx ' <br /> HH �N <br /> H <br /> C] C7 y ` <br /> � �� �110 AVCC Ai/F — <br /> Project Adtlress lif knownl r <br /> Z H� Attach lour(4)coPies ol plans fo�P�oposetl work-Draw to scaie antl note the�o�lowmg as applicable: �� <br /> y �� • Property Lines • Canterline ol street � <br /> • Outhne antl tlimensiors of ali e.�sbn, ana • �ntl�catz Nonh <br /> prOPOSCd 5(ruCtures On ihe lot • Show any proposetl 5raain9 chac;es <br /> • Ezisling and proposed utilAies • Show measuremenis M <br /> W <br /> DO NOT WRITE BEIOW THIS LINE O <br /> �� PERMIT CONDITIONS <br /> '� � 1,All calls for inspection shall be matle 24 hrs.in ativanca•phone 259•8810. � <br /> �� 2.All work shall he peAormed in eccordance wilh this permit and current City ot Everett Desiqn and Construction <br /> Slandards and Specilicationa <br /> 3.Call Lowlion Underground Service 48 hrs.belora you Ciq.TOLL FREE NUMBER 1•800•424•5555. � � <br /> � � �U�C':c c<.i� ��, y. �t �o���7'� -�'�i .:��� � <br /> v=�_ o:,,,. �... <br /> ...�. ,�.� �"' <br /> , : ., � <br /> �y�r O � <br /> ��; <br /> a � <br /> . ACKNOWLEDGEMENT OF CONOITIONS <br /> "" � The unEersigned owner/applicant hereby agrees to hold antl save harm• <br /> less the City of Everett Irom any and all claims lor damages. costs. <br /> �enoenses, or causes o� action Ihat may arise bewuse o� installation <br /> and maintenance of the �mpmvement or other righl�of�way use hereto <br /> �pplied lor and turiher agrees to remove same upon notice from ihe <br /> Approved lor Construction Date City and lo rep�ace puGlic property damaged Ihereby. <br /> FINAL INSPECTION Date Date <br /> Approved as Conslructed Signalure ot Appllwnt <br /> IVORK AUTHORIZED BY THIS ?ERMIT 1.1UST BE STARTE� WITHIN <br /> ���'�� PUBLICWORKSDEPARTMENT 780 DAYS OF DATE PERMIi IS ISSUFD AND THEREAFTER IS TO <br /> r 3200CedarStreet Bc DILIGENTLY PURSUED TO COMPLETION.THIS PERMIT MAY BE <br /> ; Everelt WA 98207 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone:259�BB70 PROJECT OVER 90 DAYS DUAATION. <br />