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� <br />� <br />TYPE OR PRINT ONLY <br />qpplica��on For <br />PUBLIC WORKS PERMIT <br />PUBLIC WORKS DEPAFTMENT <br />3200 Cedar Street <br />Everett, WA 98201 259-8810 <br />THEODORE HARCHENKO <br />Owner <br />OWNER 513-5645 <br />� Applicant <br />Jescribe Proposed Work <br />'k ) <br />�!� POSTING '�"" 10 �m <br />3823 KROMER AVE <br />ailina Address <br />NEW ASSISTED LIVING <br />10330 4TH AVE W <br />EVERETT 98201 <br />/ �i <br />Date 12/20/95 <br />Public Works Permit N `( ����-�,_ ✓ .=-- <br />/ <br />Building Permit k -.5Q3$� 5�s� <br />Public Works Fee 5 �v'�` )• C�� <br />252-9720 <br />Zip Phone <br />Zip Phone <br />02; 09, 9u 5=32r''M OOL' •d <br />.0 <br />PROJECT ADDRESS (if nown p00116052 <br />Attach four (4) copies of plans for pmposed work - Draw tu scale and note the following il applicable: C�T�ST 5'S14. �0 <br />•Property Lines 'Outline and dimensions of all existing and proposed structures on the lot •Existing and p�o�B4d util'�'�p�s �� gr <br />•Centedine of street •Indicate North •Show any proposed grading chon9es •Show meas�remenis <br />PERMIT CONDITIONS: <br />1. All calls for inspection shall be made 24 hours in advance - phone 259-8810. <br />2. All work shall be performed in accordance with this permit and current City of Everett Desig� and <br />Construction Standards and Spe�ificatior.�. <br />3. Caii Location Underground Service 48 hrs. Y,efore you dig. TOLL FREE NUMBER 1-800-424-5555. <br />�, �5 fJc?� pl�>ns «��'��e � v�� Z/9/l� . <br />�; ��� Eh�c�r'���� �z.�� o����i°� sQ-�v;�e <br />� � f�� �� ,���. <br />��� r <br />-{�, �' ��z.: �i" /l ; 6� <br />C� �.�e <<�,� � i a�� s , , ,, � <br />S�E��,,� // 5� �.%C �µ,.�.� c�:i.� r7Cc, f� o�J . <br />C. <br />�° o,ctJ, �-',,d�:.. <br />W: <br />� <br />�'^ <br />V♦ <br />� <br />O <br />� <br />� <br />O <br />� <br />� <br />� <br />a <br />ACKNON�LECOEMENT OF CONDITIONS <br />The undersigned owner.�applicant hereby agrees to hold and save hartnless <br />the Cily ot Everett ircm any and all claims fo� damages, cosis, expenses, or <br />causes ol action that may arise because of instailation and maintenance of <br />the improvement or other right-of-way use hereto applied for and funher agrees <br />tc. remove same upon notice from the City and to replace public pmperty <br />damaged Ihereby. <br />7 <br />� u Lc.�_ 'CJ l� <br />Slgnature of ApplicaN ��1e <br />OMPLEf10N.TINIS PERIAIT MA YBE ANCELLED BY TH�E CINIUPON �ANY SOTOPPAGE OF WORK ON THIS PROJ[C OVEER 90 A S Dl1LRAT10NLY PURSUED TO <br />0 <br />