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PUGbc Wo�b Permn� <br /> DetB 6-10-92 eioaoeo�.• �F9AQ <br /> Application For -� <br /> WpRKS PERMIT P���,�wo,�.F�.e : .---- <br /> PU B LI C Totel Fee <br /> Le55 A00�F!e Pe�tl �. <br /> Print or Type Only <br /> TQ F,�CTING_ 2— r�-4�( e.�e��ao�� s _— <br /> EVERETT 98208 353-8522 <br /> BIT.L BOURLAPID 8818 3RD AVE SE �.�Y Z�p ph�ne <br /> Owner Mailing Address <br /> OWNER Ciry ZiP Phone <br /> qpplicaM Mailing Address <br /> Describe Praposed Work Z UNIT ADDN TO MULTI FAMILY <br /> W <br /> p�ole��Address(if knawn) <br /> 8812 3RD AVE SE � <br /> Altach four(4)copies of plans for proposed work-Draw to scale and nole�Ceuterline of st�eet able: � <br /> • Property Lines • Indicate North <br /> • Outline and dimensions ol all ezisting and � Show any proposed grading changes � <br /> proposed structures on the lot � Show measuremenis <br /> • Exis�ing and proposed ulilities <br /> DO NOT WRITE BELOW?HIS LINE O <br /> PERMIT CONDITIONS � <br /> 1.All cells for inspection shell be made 24 hrs.in edvence•Phone 259•8810. <br /> 2.All work shall be pertormed in accordence with Ihis permit and current City of Everetl Design and Construction � <br /> Stendards end Specitications. <br /> 3.Cell locetlon Underground Service 48 hrs.before you dig.TOLI FREE NUMBER 1•800'424-5555. <br /> 1 A 1 n, 4� �J J//� O <br /> ���Lfi �C/?�`�— f�-'1.7�vt.j ' /(�Yl( /`f'�j�C,CG�li(T' � <br /> / d , <br /> �.-z� - �z � <br /> N <br /> ��.��. � O <br /> a <br /> ACKNOWLEDGEMENT OF l'�ONDITIONS <br /> The undersigned ownei/applicant hereby agrees to hold and save harm� <br /> less lhe Cdy ol Everetl Irom any and all daims for damages, costs, <br /> expenses. or causes ol action ihat may arise because of inst:.11ation <br /> and maiNenaace of the improvement or olher righFo4way use hereto <br /> appli�ed lor and tur�her agrees to remove same upon notice irom the <br /> Oate Gity anA to replac.e pubhc Property damagr.d ihereby. <br /> qppwved br Construdion <br /> Date Dale <br /> FINAI INSPECTION SignaWre of ApPlicant <br /> ApProvedasConstructed yJORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WI7HIN <br /> PUBLICWORKSDEPARTMENT 780 DAYS OF DATE PERMIT IS ISSUF:D AND THEREAfTER IS TO <br /> ��� 3200 Cedar Street BE DILIGENTLv PURSUED TO COMPLETION.THIS PERMIT MAY 8E <br /> Everett,WA 98201 CANCELLED BY TH[CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone:259•BB10 PROJEGT OVER 90 DAYS DURATION. <br />