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� r � <br />9 �-7 <br />,ozx <br />a H <br />9 H [n <br />r� x <br />yzH <br />� H� <br />7 :O <br />'ij H'TJ <br />C/� H <br />y Cg"� <br />t7 O LTJ <br />�3 C7 <br />O 1� <br />'� � b <br />G� � qC7 <br />59H3 <br />�-' y z <br />'-+ y <br />� <br />H <br />c] t7 [� <br />t7•, r <br />r� <br />H O [yi� <br />�� �m�e <br />a+ s <br />sv ` <br />�mo q � <br />Date_�'13-93 <br />ApPlication For <br />Pl�gLEC VIf1�RKS P�R�VI17 <br />Print or Type Only <br />t�ubim Wo�hs Perml: • <br />omn oeoi.+ 39231 <br />Puol¢ vJo�ks Fen S <br />Tolal Fee <br />leu Aop�� Fce Pma S <br />Balance Due $ <br />Gary �ro�s 8808 9th P1 4' Gvcrecr. l;A 98204 355-1653 <br />Ovmcr Maihng NUare�s C�ty Z�p <br />Goode Construction Inc 11217 60th St NE Lk Stevens 98258 334-9262 <br />ApPlicam <br />Descrihe Proposed Work <br />Madmg Atldress <br />Proiect Address �il known� 8808 9th F <br />Zip <br />Attach four 141 copies of plans �or propOsed wo��. - Draw lo s�-�ie and no!�� n�c lollovnng as appli[at'�e <br />• Property Lines • Centn_rlme of sireet <br />• OutGne antl dimensions of all ex�sting antl • IntliCa�B NO��h <br />proposed stiuctures on Ine lot • Sno:•� any propose�� ,;ra<nng cr,anges <br />• Exisiing and proposed utilities • Sho:� measurem�:nls <br />INE <br />PERMIT CONDITIOIJS <br />t. nll calls for inspect�on shall be made 2G hrs. in advance � phcne 259•8810. <br />�. All work shall 6e pertormed in accordance with lhis permit and currenl Cit, o' Evereu Dr,si��n and ConsVuction <br />Standards and Speci�ications. <br />3 Call Location Undei9�.:und Smvice 48 his. before you clel TOLL FFEE NUMBER 1•800-424-5555. <br />,�`� PUCiL(G VdOR{<S PERfd17 <br />� fJOT HEOUIRED <br />f1Y_ f�'n <br />DATE �-�-�-i' �j <br />+�oa � <br />! `� <br />nppiovetl !or Consiruc0on <br />Dcre <br />�:' <br />�. <br />ACFNOLNLEDGEf.1EfJT OP CONDITIONS <br />I Iv• untleisinnvd ovrner/app�icunt hereUy ag�ees lo hold antl cav^_ h:uin- <br />Ic�s Ihe �;ity a Eve�e�l lrom eny and all claims lor damages, costs. <br />oxpenses. or causes ol acuon thal may arise becausa of inslallat�on <br />antl main�enance oi the impwvement or other right�obway use herelo <br />apphed Icr and lurlhcr 2Jrees to wmove same upon notice Irom ihe <br />C�ry ���d to nrplace puhlic pioperq� dama�ed Ihereby. <br />FINAL INSPECTION D�fO <br />Api �oved as Constructed Si9na�we ol Applicani Date <br />WORK AUTHORIZED BY THIS PERMIT tAUST Bc STARTED WITHIN <br />PUBLICWORKSDEPARTtdENT 180 OAYS OF DATE PERMIT IS ISSUED AND THEREAFTER iS TO <br />,,,,FJ 3200GedarStmet 8E DILIGEIJTLY PURSUED TO COMPLETION. 7HIS PERMIT MAY 8E <br />��' Everett, WA 98201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />Phone:259-8810 PROJ[CT OVER 90 DAYS DUR�TION. <br />