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�. - I-ZS-�t- T 3 � � <br /> Pu01m Wo�k.Paimlt• <br /> Date 8'19-93 BlapDepl.e G1755 <br /> APPlicationFor P„ei�cwo�reFea S�� <br /> WORKS PERMIT tulslFee <br /> PU B LI C Less AVD�Fee Paro s_-- <br /> Bel�nce0ue s �� <br /> Print or Type OnIY 0 <br /> Craft 14410 Bel Red Rd Bellevue WA 98007 644-23 Z3P ph�ne <br /> Colony �'�Y <br /> Mailing Address <br /> Owner <br /> 2ip Phone � <br /> pwner CitY Z <br /> Mailing Address <br /> APPliceol � <br /> Describe Proposed Work <br /> rocker <br /> W <br /> Lot 41 Hanabrook 2 � <br /> 5631 lst � SE — � <br /> prolAc�Address(il known) Iicable: � <br /> Atiach four(4)copies ot plans lor proposed work• Draw to scale and nole�Centerline o�tPeet <br /> • property Lines • Indicate North <br /> • Show any proposed grading changes � <br /> • Outline end dimensions of all existing and � Show me2suremenls <br /> proposed structures on the bl <br /> • Ezisting and proposed utilities O <br /> DO NOT WRITE BELOW THIS LINE <br /> PERMIT CONDITIONS � <br /> �,p��cells for inapection shall be made 24 hrs.in edvance-phone 259-881 O. � <br /> p,qll work shall be FQ�ormed In eccordence wilh this permit and current City ot Everett Desl9^�245555uction <br /> Stendards end Speciti:.etions. <br /> 3.Call Locetlon Unde�ground Service 48 hre.before Y������� E NUM'� Z� O <br /> �� C�e� 2« <br /> � , A�, ��eti� G ' <br /> N <br /> 0 <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The u�dersigned ownerlapPlicant hereby agrees to hold end seve harm- <br /> less the City ot EvereU irom any and all claims for dameges, costs, <br /> � expenses. or causes of action that may arise hecause of instal�alion <br /> C1 .�.���� and maintenance of lhe improvement or other right•of•way use herelo <br /> � (��c .� i applied tor and further agreose� �damaged therebyn noUce irom lhe <br /> ' � Date City and to replace public p P Y <br /> ;p ved for Ccnstruction ,/� 4� <br /> / <br /> _ � �_ iv,r� -�— GC7 _- Date <br /> �G-'� Dale <br /> ure of APPlicanl <br /> FINAL INSPECTION y�ORK AUTHO���ZED e: THIS PERMIT MUST BE STARTED WI7HIN <br /> qpproved as Consiructed <br /> PUBLICWORKSDEPARTMENT 180 DAY� �!F DATE PERM�i IS ISSUED AND THEREAFTER IS TG <br /> BE Dlt�GENTLY PUPSUED TO COMPLETION.THIS PERMIT MAY BE <br /> �A� 3200 Ceder Street CAN:ELLED 8Y THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Everett,WA 9820� I NROJECT OVER 90 DAYS DURATION. <br /> Phone:259-8810 <br />