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.�.r <br /> y t+ <br /> � � � �BSB '�-] 9-91 v„o��cwo�wer��mn. <br /> � BwaDeot• 91�77757 <br /> c H Applicationr.,r <br /> � � i <br /> PUBLIC WORKS PE.RMIT PUEiicWorbFee s <br /> To��i Fee <br /> Kn 1m��001 Fee O�q S <br /> O C O BaienceDue S <br /> � y � Print or Type Only <br /> z <br /> � � � Paul Gadbois 2102 Melvin Ave Everett 9fl203 355-2152 <br /> � 'A Owner MaiVing ACdress City ZiP Phone <br /> M ~ � <br /> N ¢ <br /> M y Surety Insurance Repair 11630 Slater Ave NE Y.irkland 98034 823-�248 <br /> 8 N Applicant Mailing AtlCress City ZiP Phone <br /> fl O N <br /> � ti � SFR fire damaqe renair <br /> y y Describe Proposetl Work <br /> H 6 N <br /> W <br /> ProjectAddresslifknown� 2102 Melvin AVe . � <br /> Attach lour(4)copies oi Plans lor proposed work•Draw to scale antl note the lollowing as applicable: � <br /> • Property Lines • Centerline of street � <br /> • Outline and dimensions of all existing and • Indicate Ncrth <br /> proposed structures on lhe lot • Show any proposed grading changes <br /> • Existing and proposed utilities • Show measurements /� <br /> W <br /> DO NOT WRITE 6ELON'TNIS IINE O <br /> � ■ <br /> !!! PERMIT CONDITIONS <br /> C j 1.All calls tor inspection shall be made 24 hrs.in ad�ance•phone 259•88�0 � <br /> 2.All work shall be peAormed in accordance with this permit and current City ol Everett Design and Construction <br /> i Standartls and Specifications. ' <br /> I _ 3.Call location Undergrovnd Servics 48 hrs.bebre you dig.TOLL FREE NUMBER 1•800•424•5555. � <br /> � <br /> f_—I O <br /> ,.�� . . . , . . . . <br /> � , <br /> ��' („� <br /> I �� ♦r^ <br /> V♦ <br /> 1"��� � <br /> � <br /> a <br /> �,_, <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees lo holC and s_ve harm• <br /> � less ihe City ol Everett Irom any and all claims for damages. costs, <br /> �1`� expe�ses, or causes of aclion ihat may arise hecause ol installatio� <br /> � and maintenance ol lhe improvement or other righlro6way��•se hereto <br /> � applied lor and luhher agrees to remove same upon notice Irom Ihe <br /> Approved for Construction Date C�ty and to rep�ace public property damaged Ihereby. <br /> FINPL INSPECTION �a�e �ate <br /> Approved as Consiructed Signature ol Applicant <br /> WORN AUTHORIZED BY THIS PERMIT MUST BE STARTEi, WITH�N <br /> Or� PUBLICWORKSDEPARTMENT 100 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTCR IS TC <br /> 3200CeCarStreet BE DILIGENTLY PURSUED TO COMPlET10N.THIS PERMIT MAY BE <br /> Evere4 WA 98201 CANCELLED BY THE GITY UPON ANV STOPPAGE OF WORK ON THIS <br /> Phone:259�8010 I PRCJECT OVER 90 DAYS DUAATION. <br />