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Date Z�Z3 93 ( <br />AppliCnlion For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />a�m.� wmu r��mn . <br />e�av oeo� • 39656 <br />wo�a waw Iee <br />lal�llee a <br />leu �onl fee VyE S <br />e.ia�c.o�e 3_ <br />Gernld Do1lacUide 2120 Mukilteo Blvd Everett 98203 353-7747 <br />Owne� Maibng Atldress Ci�y Zip Phone <br />Ovncr <br />Applicant MailingAtldress C�ty Zip Phon= <br />Descnbe Proposetl Work <br />Pmjecl Ftltlress (it knowry <br />Nev 990sf garage <br />2120 mukiltco blvd <br />Attach low �4� o9pies ol plans lor prapoSeE work � DrTw to scale antl note ibe lollowing as applicaEle: <br />• Propetly L1nes • Cen;e�hne ol5ireet <br />• Oulhne and tllmensio�s ol all e.rsOng antl • InE¢alc North <br />proposed simctures on I�e lol • S�ow any proposetl grntling changes <br />• EMisling anE pmposetl ulillties • S�ow measuremenls <br />PERMIT CONDITIONS <br />1. All ta1191or Inspec�ion Shall ba maEe 24 hts. in edvanCa- OhOne 2$S•8810. <br />2. All work shall �e pedormeA In eccortlanca with 1�I5 permil antl current City ol Everelt Uesipn and ConStmclion <br />Stantlnrtls end Specilitalians. <br />3. Call locatmn Underground Service 4B hrs. belore you tlig. TOLL FREE NUMBER 1•804� �.24•5555. <br />PUBLIC WORKS PCpM1T <br />NOT REOUIRED <br />BV '']b <br />DATE_ 7 �"� •`i:S <br />ApP�ovetl lo� ConslruCiion <br />RNAL �NSPECTION Oale <br />Approvetl as Conslmaud <br />�PUBLICWORKSOEPARTMENT <br />3200 Cetlar Sheet <br />Everel4 WA 90201 <br />P�one:259�8810 <br />ACKNOWLE�G[MENT OF CONDITIONS <br />The unEersigned ow ner/applicant �eieby aqmes lo holC ana save harm� <br />Icss the Ctly ol Eveeett Irom any and all ela�ms br 4ameBes. cosis <br />wpenses. or causes ol atlion Ihat moy arise because ol installahon <br />anE maintennnce of the improvemenl or other �ighPo4way use hereto <br />applietl lor antl Ivrther agrees to remove same upon not¢e Oom IM1e <br />City and to replare publ¢ prope�ry damaBeE Ihereby. <br />Signalme ol Apohwnl �ate <br />IMORK AUTI/ORIZEC BV THIS PERMIT MUST BE STARTED WITHIN <br />I80 DAYS OF DATE PERMIT IS ISSUED AND THEflEAFTER IS TO <br />BE OILIGENTLY PURSl1ED TO COMPLETION. Th115 PENMIT MAY BE <br />CANCELLED BV TME GTV UFON ANV STOPPAGE OF P::,9K ON TMIS <br />PROJECT OVER 90 DAYS DURATION. <br />