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� <br />�� <br />TYPE OR PRINT QNLY <br />Applicatbn For <br />PUBLIC WORKS PERMIT <br />PUBLIC WORKS DEPARTMENT <br />32pp Cedar Street <br />Everelt, WA 98201 (425) 257-8810 <br />TO POSTING"� 2�- <br />.� <br />Date 5/17/99 <br />Publfc Works Permit 8 -�- 1/,�,� <br />-� <br />Building Pertnit x C62488 <br />Public Works Fee $ � <br />RON LARSEN 3213 56TH ST SW EVERETT 98203 425-1896 <br />Owner Mailing Address Ciry Zlp �0�e <br />OLIN <br />Describe Proposed Work NEW <br />PROJECT ADDRESS (ii known) �5� 2 <br />Attach four (4) coples ptans for proposed work - Drew to scale anA note the idlowing if epplicable: -- '�� utilitles �-, <br />• Propefty Lines • Outline and dimensions ol all existing end pro{wsad stnictures on the bt • EdsNng erM �p�oposed _, <br />• CenteAine of sneet • Indicate NoM • Slww any proposnd grading changes • Show measurements <br />DO NG',' `JVAITE BELOW THIS LINE <br />F' � <br />PERMIT CONDITIONS: <br />1. All calls lor inspection shall be made 24 hours in advance - phone (425) 257-8810 ., . <br />2. All work shall be peAormed in aceordance with this permit and current City oi Evarett Design and, � <br />Construction Standards and Speci(ications. , <br />3. Call Location Underground Service 48 hrs. betore you dig. TOLL FREE NUMBER 1-800-�24•5555: <br />4. -�'i�,{�1't� iVIC �� D*Y 'L� �'W�}P � d�T+�Rc�,� �rK P.�� �i o� o� (v� <br />s s�� .��- p�- �� <br />� 1,..�— .+� � <br />FINAL INSPECTION <br />Approved as Constnuted <br />(�o l, GvZ , �a4 , <br />Date <br />OU <br />W <br />� <br />� <br />N <br />ACKNOWLED(iEMENT OF CONDRIONS <br />The urdersigned owneNappllant hereby agreea to ho�d and seve hermless <br />the Ciry of Everetl irom airy and dl elaims for demepes� ae�s� expa^sea, or <br />ceuses ot actlon tliat mey adsa beceuse M krotelblb^ antl mefntenence o11M <br />improvement a olher dyht�ot•wey use hereb applled lur arW lurther aprees b <br />removes�q upon raNee hom Gry reWe�e P�w P�KY �^. <br />aqeA MerebJ. � <br />i <br />/ ' c��6�-� G� . 'S - 5 � <br />re o ican <br />��-ri�ori.n��is��tiw�r�Eoe�an�uaoa��ms�o�i Ea�wowc ����ov�e�owrsou�v�oTo <br />