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, , . <br /> ; � <br /> i <br /> � <br /> ��� _,., i <br /> C <br /> ��� 2 I <br /> �w���yy Date1�31,L92 G~; . - —. I <br /> H � �l� vvp�¢Worxe Permn• <br /> APPIiCetion For Biau oeo�..�7�i5597 I <br /> ��g PUBLIC WORKS PERMIT PVeioiAFeeFeo s i <br /> n• gC� LxssAoo<<eaP�i� $ <br /> s y� Print or Type Only Beinnce D�e s _ <br /> C� <br /> hi H <br /> GO <br /> g~ N. J. Jarman 11119 - 3rd Ave SE Evcrett 98208 353-1536 � <br /> [U� <br /> � ON�ner Mailing Adtlress Ctly Zip Phone <br /> p y owner <br /> I <br /> � ��- l,pplicanl Mailing Adtlress City 2ip PhOne <br /> Desc;�be Proposed Work �nStiuCt neW gaLage <br /> _ � <br /> � <br /> Project Atldress(if known) 11119 — 3rd Ave SE � i <br /> ARach lour(4)copies of plans br proposed work- Draw Io scale and note the lollov I NITUL I NaPlCTION _ � <br /> • Properry Lines • Cente� KIRK BR60K6 ♦^ � <br /> • Outline and dimensions ol all existing antl • Intlica� r�-. "♦ <br /> _ proposed structures on the lot • Show� � j� _ yL <br /> \ • Existing antl proposed utili�ies • snow�� DATE <br /> P .����j DO NOT WRITE BELOW THIS LI � F y � � ' <br /> 1 �' PERIdITCONDITIONS �I ��� � � O � <br /> �_, 1.All calls kr inspection shall be ma�'e 24 hrs.in advance-phone 259•$! , / V � ,L <br /> I � 2.All work shall be pertormed in accordnnce with ihis permit and current C ` I ` t� ' . <br /> Stendards end Specilications. <br /> 3.Call Location Untlerground Servico 49 hrs.6elore you dig.TOLL FREE 1 � , <br /> �, �� O <br /> /�/� / ) �/ � <br /> w / l/6Eo-e_ CUCtI:��i.�t,J.,.�-f�G�G�/ ie-cf�(��. .-�� <br /> f '' „ :. � <br /> �/ <br /> 1�j, � p <br /> , <br /> __ a <br /> � <br /> ( ��i ACKNOWLEDGEMENT OF CONDiT10NS <br /> � � The unders9netl owner/applicanl hereby agre�!s to hold and sare harm� <br /> - less Ihe Cdy ol Gveretl Irom any and all claims lor damages, costs. <br /> eapenses, or cause� ol action thal may arise because ol inslallation <br /> and mainlenance ol ihe improvemenl or other righl�obway use hereto <br /> Approved lor Construction epPlied lor ond luriher agrees to remove same upon notice from the <br /> Date Ciry antl Io replace public properry damaged there6y. <br /> FINAL INSPECTION Date <br /> Approved as Conslrucled Si3naluie ol AppLcanl Date <br /> PUBLIC WORKS DEPAR7MENT W�F7K AUTHORIZED 8Y THIS PERMIT MUST BE STARTED WlililN <br /> 3200CedarStreet 1dG DAVS OF DATE PERMIT IS ISSUED AND THEREAFTEA IS TO <br /> Everelt,WA 90201 BE DILIGENTLV PURSUED TO COMPLETION. THIS PEFMIT h1AY H[ <br /> Phonc:259�8810 CANCELLED BV TNE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVEH�JO DAYS DURATION. <br />