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8i 2qz <br /> pypp�Wo�k�Permit� <br /> 9/27/84 eiaaDeot• 84 1357G <br /> D9te�— ----- <br /> Applicelion For P„pi;�wo�ks� <br /> Tol�l Fae <br /> pUg��C WORKS PERMI �e�sADo�FeePeid : 2 0 <br /> Babnce Due s�� <br /> ✓��;Z'lGk <br /> Print or Type Only <br /> Everett <br /> 98201 252-2633 <br /> 2615 Maple phone <br /> Pdul M. Kukowski C.'Y Z�P <br /> Mailing Address <br /> Owner <br /> S�e ZiP Phone <br /> Mailing Address <br /> City <br /> qpplicant i <br /> Construct Car–port <br /> Describe Proposed Work <br /> W <br /> — 2615 Maple --- � <br /> Prolact Address�if know�) � <br /> Attach four(4)copies of plens tor proposed work• Drnw to scale and note�Ce°�1eW�ne ol str�ee�a61e: <br /> � property Lines • Indicate North <br /> • Show any proposed grading changes � <br /> • Oul;ine and dimensions of all existing and � S��oW measurements <br /> proposed structu�osed uthl ties <br /> • Exislin9 3nd P�oP O <br /> DO NOT WR�TE BELOW THIS LINE <br /> PERMIT COND�TIONS � <br /> 1, AII calls for inspection shall be made 24 hrs. in advance- Phone 259•B81 5. � <br /> 2. All work shell be performed in accordance with this permit and wrrent City ot Everetl Design and Construction � � <br /> Standards and Specifiwtions. �. <br /> 3. Call Locallon Underground Service 48 hrs.before You dig.TOIL FREE NUMBER 1'800•424•555 . M <br /> O <br /> � H � <br /> y � <br /> H r: <br /> O � �r <br /> d l. <br /> � <br /> a � :. <br /> � <br /> � � <br /> � <br /> V . ACKNOWLEDGEMENT OF CONDITIONS � . <br /> �F' . rees to hold and save harm� � �.� <br /> The undersigned owner/app��can�hereby ag � <br /> �l� �`Z less ihe City ol Evere�� from any and all claims for damages, cosls. N o <br /> expenses, or causes ol aclion that may arise because of installation M � <br /> �,� /� � �� and maintenance ol lhe improvement or other right-ol-way use hereto E. <br /> �1� ��� applied for and lurther agrees �o remove same upon notice Irom the <br /> Date Gity and lo rePlace public property damaged thereby. � `, <br /> Approved 1 Construction � � �t /� <br /> � � � �f � � I� � �' <br /> �i/��y-� _ �ti� ;. <br /> � Date <br /> Da'e Signature of Applicant <br /> Fl�$FEGTION � ; <br /> Approved asConstrucled WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> pUBLIC WORKS DEPAATMENT 7B0 DAYS OF DATE PERA7IT IS ISSUED AND THEREAFTER IS TD ' <br /> everett 8E DI'.IGENTLY PUHSUED TO COMPLETION. THIS PERMIT MAY BE <br /> � 3200 Cedar Slrect CANCE ILED BY THE GTY UPON ANY S70PPAGE OF WORK ON THIS <br /> Evere�l.WA 9g2�� pROJECT OVER 50 DAYS DURATION. <br /> Phone: 259�8815 <br /> r <br />