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� � <br /> a�x .. <br /> ��3tn <br /> H�I�-i <br /> K n <br /> y0 � <br /> �y� Date 10-OS-92 TO POSTING '°°°°W°��„°�m^` �Z yzn <br /> � 5 —ze-q 3 eiac oeo� • 3830$ <br /> O^� APPlication For _ <br /> �5 RUBUC WORKS PERMIT PuoToteifeafea s <br /> � <br /> CRI Less RoO�.[ee PaiE S �/ <br /> �� Beianccoue S 7 7� `y� <br /> �y y Print or Type Only �3G�S �6. <br /> t' � %i^<�c n�if.��.f.o�, <br /> NH <br /> H <br /> ~ Columbia Paint 14615 NG 190th St Woodinville WA 98072 486-1455 <br /> ��H <br /> Owner Mailing Address City Zip Phone <br /> �� Owner Contact: Gale Conner <br /> Applitant Mailing Address Cily Zip Phonc <br /> DesCribe F'roPosed Work ReW retail aint SCOTe <br /> W <br /> Project Address(il known) 2� � �P�C���G �!/L. � <br /> Attach lour(4)copies ol plans�or proposetl work• Draw to scale and note the lollowing as applicable: � <br /> • Property Lines • Cenlerline ot strect ♦A <br /> • Outline and dimensions ol all eaisting and • Indicate Norfh V� <br /> propqsed structures on Ihe lot O Show any proposed grading changes <br /> • Existing and proposed ut�lities • Show measurements M <br /> f 1 DO NOT WRITE BELOW THIS LINE W � <br /> ��' PERMIT CONDITIONS O <br /> '�' 1.All calls lor inspection shall be made 24 hrs.in advance-phone 259•8810. � <br /> 2.All work shell be peAormed In eccordance with this permit and curreM City ot Everetl Design and Cons�ruction <br /> Slandards and Specilications. <br /> '�I 3.Call Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1•800•424•5555. � <br /> � n�-Ze./ <br /> � �.�Yt.� Xu �C ��7t�,. .t7c� 4�/_'l.�z•ti�✓•/a�n.n: c� O <br /> � ; � C�:�-G j � _ <br /> � ��.�-c,�.�_fY /��-Gl�r, !<<,zl� �,��Ls-f�• �_�. <br /> �_ ,/2/y�- ��) 1- <br /> ; �c�,�.�' <<��is�� � <br /> —� 0 <br /> -� a <br /> _� <br /> ' ACKNOWLEDG[MENT OF CONDITIONS <br /> . The undersigned owneUapplicant hereby agrees to hold and save harm- <br /> less the City ol Everett Irom any and all claims tor damages. cosls. <br /> expenses, or causes of action Ihat may arise because ot installa�ion <br /> `� ./-O ,/ and maintenance ol �he improvemenl or oiher right-obway use hereto <br /> �j��Z.��^ ��/7�� applied lor and lurther agrees to remove same upon notice Irom Ihe <br /> Appmved'to�Construclion ��� C�ty and to replace puUlic property damaged ihereby. <br /> .�`S/�-f- �- �/- •� /�� 1,!/ la/ -,_ /o?- �/-9z <br /> fINAL INSPECTION �ate Oate ' <br /> ApPwved as ConstruCted Signature of ADP�icant <br /> � WORK AUTHOFIZED �V THIS PERMIT MUST BE STARTED WITHIN <br /> PUOLICWORKSDEPARTMENi 180 DAYS OF DATE P[RMIT IS ISSU[D AND THEREAFTER IS TO <br /> � 3200CedarSireet p[ DILIGENTLY PURSUED TO COMPLETION.TfiIS PERMIT MAV BE <br /> =��t Everett,WA 98201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WOAK ON THIS <br /> Phone:259�8010 PROJECT OVER 50 DAVS DURATION. <br />