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xt�"'~4 <br />C�J [*J <br />9 �H <br />x V� <br />H Z� <br />fC C) <br />H �1 <br />� H htl <br />y H <br />x <br />� � �i <br />OH <br />H�g <br />�. � <br />zH�yH <br />rHH <br />g �' <br />C'] G y <br />� � C�1 <br />H O tyi� <br />Date 10 9 92 <br />Application For <br />Pl;BLIC WORKS PERMlT <br />Print or Type Only <br />Puf.�.c workc permit • <br />�,�,� o�p� . 38319 <br />vuoi.c lVorAa fee <br />Tutal Fcc $ <br />LessAool Poe Pa�� 5 <br />aam���.n„o S <br />David & Martha Pauley 1626 HolUrook Ave Everett 98203 355-5383 <br />Owner Mailing Address Ci�y Zi <br />� Phone <br />mainiy <br />City <br />Describe Proposed Work _ Convert qaraqe to rec room & construct new qarage <br />Project Adtlress (il known) <br />Attach four (4) copies ol plans lor proposed work - Oraw �o scale and note Ihe lollowing as applicable: <br />• Property Lines <br />• Outline and dimensions of all existing and <br />prop05ed structures on the bt <br />• Exislin� and proposed utilities <br />• Centerline ol slreet <br />• Indicate North <br />• Show any proposed pradinc� chanc�es <br />• Show measurements <br />Phone <br />PERM�T CONDITIONS <br />1. All calls lor inspection shall be made 24 hrs. in advance- phone 259•88�0. <br />2. All work shall be peAormed in eccortlance with ihis permit and currenl Ciry ol Everett Design and Consiruction <br />Standards and Specilieations. <br />3. Call Location Underground Service 48 hrs. betore you dig. TOLL FREE NUMBER 1-800•424-5555. <br />_� <br />��.l��l�y�zr.'<���f/G'F�,�����<� : <br />,, , <br />..?��. ;� � <br />-�_. <br />/(ir � n <br />��� <br />ApProved lor Construction Date <br />FIN�L INSPECTION Dale <br />Approved as Constructetl <br />��PUBLIC WORI(S DEPARTMENT <br />3200 Codar Street <br />Fvcrett, WA 98201 <br />Phone:259�88t0 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />W <br />� <br />� <br />� <br />� <br />Q <br />The undersigned owner/applicant hereby a9rees to hold and save harm� <br />less Ihe Cily ol Everett Iwm any and all claims lor Aamages, costa <br />expenses. or causes ol action Ihat may arise because el inslallation <br />and maintennnce of Ine improvement or other righFel�way cse hereto <br />applied tor and lurther a9rees to remove same upon notice Irom Ihe <br />City and to replace public properry dama9ed thereby. <br />Si�nafure ol Applicant Date <br />WOFK AUTNORIZED BY THIS PERMIT MUST BE STARTED WITFIIN <br />1B0 DAYS OF DATE PERMIT IS ISSUED ANO THEREAFTER IS 70 <br />�E DILIGENTLY PURSUED TO COMPLETION. THIS PEHMIT MAY BE <br />CANCELLED BY THE CITY UPON ANV STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />--;; <br />