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� M <br />� <br />y <br />Cy, � <br />F� y <br />K �] �i <br />ro N H <br />� y � <br />°x c~i <br />��� <br />¢ M <br />b H <br />p� <br />H <br />N <br />M <br />O N <br />��yera <br />O N <br />N <br />� �� <br />Dale. '-'9-92 � <br />qpplication For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />7hnant-Petershagen (JK Gill Remodel) <br />Prowess Inc. 22313 <br />Botesh, Nash 6 Hall <br />AVe W <br />i Address <br />Address <br />Descrihe ProPosed Work 'Penant imniovemenY <br />Proiect Address (il known) <br />{�n <br />Cily <br />0 <br />r��i�c wa��a ammn . <br />3G855 <br />maa oeo�- • <br />Pue4c Worb Fee 5 <br />lo�aiFee <br />Leff AO�I Gee PaN 5 <br />oalanceDue � <br />Attach lour (4) copies ol plans lor proposed work - Draw lo scale and no�e � Cen1te line of sVeet able: <br />� prpperry lines • Indicate North <br />• Outline and dimensions ol all ezisting and � Show any pmposed grading changes <br />proposed siructures on the �ol • Show measurements <br />• Exisling and proposed utilities <br />259-0868 <br />Phone <br />1 PERMIT CONDITIONS <br />'� � 1. All calls for inspection shall be made 24 hrs. in advance • phono 259•8810. <br />2. All work shall be pedormed in accordance wilh this permil and current Ciry of Everelt Design and Consimclion <br />� � Standards and Specilications. <br />� 3. Call Location Underground Service 40 hrs. belore you dig. TOLL FREE NUMBER 1•800•424•5555. <br />,__ <br />� <br />, <br />, <br />i c: 6 ! , �l �, , : , . - / , . , . % . �.' r.: <br />ApP�oved for Constructio� Dale <br />FINAL INSPECTION Dale <br />qpproved as Constructed <br />�PUBLIC WORKS DEPAR7MENT <br />3200 Cedar Street <br />Everetl, W.198201 <br />phone: 259�8810 <br />� .���� J <br />; <br />�� -as" � ._ <br />_�.l-' <br />, <br />Z <br />O <br />�"' <br />� <br />0 <br />a <br />ACKNOWLEDGE�.tENT OF CONDITIONS <br />The undersigned owner/apPlicaN hereby a9rees to hold and save harm� <br />less the Cily ol Everetl Irom any and all claims for damages, costs, <br />expenses, or causus ol action Ihat may arise because of installation <br />and maintenance ot Ihe improvement or other righ4ol�way use hereto <br />applied lor and turther agrees lo remove same upon notice Irom the <br />Ciry and to replace publlc property damaged lhereby. <br />Signalure ol ApP�icant Date <br />80RDAYSTOFRDATE� PERMIT SESSUED AND THEREAFT�ER ISHTO <br />BE DILIGENTLY PUFSUED TO COMPLETION. TNIS PERMIT MAY BE <br />CANCELLED BY THE GTY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />