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PHONEt <br />PUBLIC W�RKS <br />PERMIT <br />PUBLIC WORKS DEPARTMENT <br />3200 Cedar Slrcet <br />Everett, WA 98201 <br />(425) 2.�iME'1 <br />HARCHENKO THEODORE & <br />3823 KROMER AVE <br />EV^cRETT WA <br />(425)513-5645 <br />98201 <br />TAXPFRCELi.O.M 2428--N42-007-005 <br />DESCRIPTION OF <br />PROPOSED N'ORK'. <br />IC�NTNAME <br />ADDRESS: <br />PHONE: <br />Date <br />Public Works Permit a <br />Building Permit a <br />Planning Relerence a <br />Pu61ic Works Fee S <br />S <br />nooness 10330 4TH AVE W <br />IONAL 22 UNITS - ASSISTED LZVING <br />sovrt�otxr nss�sr� uvtxa <br />PERMIT CONDITIONS <br />stza-000-o� i-oias <br />5/i5jlCldt� <br />PW0005-021 <br />B0005-015 <br />$ 1,332.00 <br />1. All calls lor inspeclion shall be made 24 hours in advance • phone (425) 257-8810 <br />2. All work shall be pertormed in accordance with this permil and currerl Cily of Everett Design and Cons�ruction <br />Standards and Specifications. <br />3. Call Location Underground Service 48 hrs. belore you dig. TOLL FREE NUMBER 1-800-424-5555 <br />4. As per approved plan5 dated 6/5/00 and the puhlic works inspectors <br />instructions in the field. <br />T�'; F��STIt�G <br />Appr�vfU lor ConsiruC�ion Dale <br />� �� �i'Z "+O+Z <br />/,5./�e ` w-= <br />FINAI�II�_SP TION <br />AnnfOVQtl 05 CO�SINC�PO ��IB <br />�IAY 0 8 2002 <br />_ _ . .:; -_ _. . <br />�_-1;"� �• � . vo I�a�� tiS <br />Il/RJW :64. CU <br />;'t:;'TNSF i29.C-0 <br />C�1��Efi 260.c� �s� <br />--�'�"�_ ]332.(�J <br />-,: l�'._ <br />ACKNOWLEDGEMENT OF CONDI?IONS <br />W` <br />r' <br />V+ <br />m <br />O <br />� <br />The undersigned ownedapplicaN hereby agrees b hold and <br />save harmiess the City ol Everett Irom any antl all claims for <br />damages, costs, expenses, or causes of action that may arise <br />because ol inslallation and maintenance ol the impmvemenl or <br />other nght-o6way use hereto aoplietl for and funher agrees to <br />remove same upon notice Irom il�e Ciry and ro replace public <br />pmpe tlamaged thereby. � / <br />�L_ � .Ic.Gceutl %/.�fC�'� <br />SignaNre ol Appltiant Date <br />WORK A:JTHORI2ED BY THIS PERMIT MUST BE $TARTEO WITHIN 180 OAVS OF DATE PERMIT IS ISSUED AND THEfiEAFfER IS TO BE DILIGENTLV ('URSUED <br />TO C067PLETION. TMIS PERMIT MAY BE CANCELLED BV THE CITV UPON ANY STOPPAGE OF WORN ON THIS PROJEC70VER 90 DAYS OUFATION. <br />