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i <br /> �„o�,�w�,.,,�.,�,. _ <br /> Date_ _ <br /> Biay Dnoi � - <br /> Applicahon For <br /> PIJBLIC WORKS PERMIT °°°to,:F:�"' s <br /> L�f��00� Fee P��a S <br /> Flaienrr O�e S <br /> Print or Type Only <br /> Plan Check No: 8 36856 S6Pa <br /> Applicat.Date: OS 28 92 <br /> Job Addreee: 22 -1 9TH PL SE <br /> Owner: TREMAYNE JAMES M �p Fhone <br /> Owner Tenant: <br /> Propoeed Uee: SINGLE FAMILY RESIDENCE <br /> Deec. of Work: <br /> 3005F FAMILY ROOM ADDITION �p Phone <br /> Apphcant <br /> OFFICE SET JOB SET <br /> �escr�be Proposed Wo•k _ APPROVED FOR PERMIT: DATF_/_/_ BY <br /> - W <br /> P�oicr.t Add�^ss Id 'vnownl <br /> G25- l09TH .�'L SE — I... <br /> � <br /> Attach four 1�1 copies of plans for prupesed work� Uraw to scale and note the followmg as applicable � <br /> • Property Lmes • Cenlerline ol sireet <br /> • Outline and dimension5 0l all rMiSt�nq and • Indite�e Noith <br /> proposed slructu�es un Ihe '�ot • Show eny proposeA grading changes <br /> • [.isting anA proposed utildies • Show mea5urements M <br /> W <br /> DO NOi WHITE BELOW THIS LWE O <br /> �ENMIT CONDI110NS � <br /> t nll calls lo�Insnec�lon shell be mede 24 hrs.in advence� phone 259•8810. <br /> : MI work shall be perlon:ied�,n eccordance wilh ihis permit end current Ciry ol Everetl Desiyn ard Construction <br /> StanAards end SOecilir,n�ions. � <br /> :a Cail l.ocalion Unde�ground Service dB hrs.belore you diy.TOLL FREE NUMBER �-800•424•5555. <br /> �, �- f v.S ��� 11/or /�s /�r�►� % f ��� -� � � <br /> ?�t,,,� /I1�,�� �"' <br /> � i�. —Z3- 9`� � <br /> 0 <br /> /�aTe �� , F �0o,7��ti ,s B�,�T ov�z s,�- �- <br /> ' <��vE2 - �r Nlvsr Bc—' cJ P Dri7�-v T� <br /> /l�r� C� nG ACKNOWLEDGEMENT OF CONDITIONS <br /> G[ � /' <br /> The undersiyned owner/applicaM he�eby agrees to ho'd antl savc harm� <br /> _. . . - --- �— le« Ihe City ol Everelt Irom any and all cleims lor damuges, cosis, <br /> e.penses. or causes ol action Ihal may eriae because ol Installntion <br /> and mam�enance ol Ihe improvemenl or other iighl�obway use herelo <br /> applied lor and lurther agrees to �emove same upon notir.e Irom Ihr. <br /> -----� Date <br /> qppro����t '��� i � �� ."��� t��.�n Cdy and t0 replaGe publit p�operty damayed iher¢ y- <br /> flNnt ird;f�CCiION _____..____Date Dalr, <br /> Apt��� �� ' ���� �� �n5lrucled Signature o�ApphCanl <br /> WOHK AUTHORIZED BV THIS PERMIT MUST BE STARTED WITHIN <br /> � � 1`UBLICWORKSDEPAPTMENT 180 DAVS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � �f700CedarSlreet BE DILIGEKTLY PURSUED TO COMPLETION. TNIS PERMIT MAV BE <br /> ���7 fbcrn�L WA 98201 CnNCF.LLED BV THE CITV UPON ANV STOPPAGE OF WONK ON THIS <br /> ;�nnn�,. 259�BB10 !,Ri�.lf ��.T '�NF.R �0 f1AVS DUHATION <br />