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� Gi <br /> � <br /> D31C 10-25-91 , a�ei�cworwar��mn. . — I <br /> eioo oeoi . �l/28023 <br /> Applicalion Fot <br /> PUBLIC WORKS PERMIT °°°t�,�F�;`°° $ <br /> Les��co�Fee Peie s � <br /> y C� 9aiarce o�• 5 <br /> '�xj a y Print or Type Oniy <br /> C�H <br /> 9 y y ['erol Detz 1102 Fucker Ave liverett 98201 <br /> y �H Owner Mailing Atldress Ciry Zip Phone <br /> �C CJ <br /> H� <br /> � H O� Carl Larsen Const 4801 76th SW Mukilteo 96275 355-4745 S aron arsen <br /> CA H Applicant Mailing Address City Zip Phone <br /> y C <br /> � zz� <br /> H C Describe Proposetl Work nddn to garage <br /> OH <br /> � �g <br /> G]V [� <br /> xy� � � <br /> � H y 1102 Rucker Ave � <br /> Cy V7 Prolect Adtlress(il known) <br /> i <br /> ❑n dC� Attach lour(4)copies ol plans lor proposed work- Drew to scale and note the lollowino as applicable: � 4 <br /> 3 [�1 t" • Property Lines • Centedine ol street /♦ � <br /> • OuUine and dimensions ol all ezisling and • Indicale Norih V <br /> •y p y • proposed structures on Ihe lot • Show any proposed grading changes <br /> • E.isting and proposed utilities • Show measurements /� <br /> LL <br /> DO NOT WRITE BELOW THIS LINE � . <br /> PERMIT CONDITIONS � <br /> � t.AII calls lor inspection shall 6e made�4 hrs.in advance-phone 259•8810. � � <br /> 7.All work shall be pedormed in accordance with Ihis permit and wrrent City ol Everelt Design antl Construction � <br /> Slandards and Specilications. ' <br /> � 3.Call Lowtion Underground Service 48 hrs.before you dig.T'OLL FREE NUMBER 1•800•424•5555. � �. <br /> � <br /> � � i <br /> a` � � �' � � C � <br /> 1 /U��:, /���>,, '.� dr.;. . i ��' �i:�� � <br /> ` �� � , <br /> i 4i ��-�- '� <br /> � <br /> ;�; a <br /> � j� ACKNOWLEDGEMENT OF CONDITIJNS <br /> The undersigned owner/applicant hereby agrees to hold and save harrr <br /> Iess Ihe Cily of Everelt Irom any and all claims for damages, cosL <br /> !��' eapenses, or causes ol action Ihat may arise because ol installatio <br /> � and mainlenance of the improvement or olher tigh4ohway Use herel. <br /> applied for and lurlher agrees to remove same upon noBce Irom th� <br /> Approved lor Conslruction Dale Cily and to replace public pmperly damaged lhereby. <br /> FINAL INSPECTION Date <br /> Approved as Constructed Signalure ol Applicanl Date <br /> PUBLIC WORKS DEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHI� <br /> 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TC <br /> 3200CedarStreet B[ DILIGENTLY PURSUED TO COh1PLETION.THIS PERMIT MA': Bl <br /> Everelt,WA 98201 CANCELLED BY THE GTY UPON ANY STOPPAGE OF WORK ON THI: <br /> Phone:259�8810 pROJECT OVER 90 �AYS DUFATION. <br />