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I <br /> ! �8te 7-19'91 �� ^ o�euc worw�cmm�• . <br /> APPlicatlon For e�aa o.o� . 91/27371 <br /> PUBLIC WORKS PERMIT Pu0Tca1Wo`�Fes � <br /> I <br /> �����oo�Fe�PaE � <br /> Prfnt or Type Only e.�.�<so�s s _ <br /> Middleton, Doyle E 209 110th P1 SE Everett 98208 353-7769 <br /> Owner Mailing Adtlresa City Zip Phone <br /> i <br /> � <br /> OWI18! <br /> ' Applicenl Malllnp Addrese Clty Zip Phone <br /> I <br /> Daecribe Proposed Work GaLaae 780 SF <br /> W <br /> Nro�ecl Addreee 111 known) ��Q >>0 h Pl c . � <br /> Attech tour(4)coples ol Dlene lor propoeed work- Drew to ecale end note Ihe lollowing es epplice6le: � <br /> • Property Llnee • Centerlina ol etreel � <br /> � Outline end dimenelone ol all exleting end • Indicete North <br /> propoead etrucluree on Ihe lot • Show any propoead prading chenges <br /> ' • Exletlnp end pro0oeed utllitlee � Show meeawements � <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONB <br /> 1.All calle far Inepectlon ehall be mede 24 hre.In advance•phone 259•8810. � <br /> 2.All work ehall be perlormed In eccordence with thla permit end current Clty ol Everett Deelgn and Conelnwtlon <br /> 3tanderda end Spxllicetlone. <br /> 3.Cel�Locatlon Underpround 9ervlce 4B hro.before you dip.TOL4 FREE NUMBER 1•800-424Bb55. � <br /> O <br /> N�, �v i����, �,t �E�. � <br /> ,��.���- O <br /> -� z� -9� a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/epplicanl hereby egreea to hotd end seve harm� <br /> — lesa the City ol Everetl Irom eny end all cleima lor demeges, costs. <br /> expenses, or cauaes ol actlon that mey erlee beCauae ol Installetion <br /> end melntenence ol the Imptovemant c�r!her rlght�ol�woy use hereto <br /> epplled lor end lurlher egrees to remo•-a seme upon notica from the <br /> App�ovad lor Conatruction Dete Clty and to replece public proparty demeqe7 thareby. <br /> FINAI IN8PECTION Date <br /> Approved en Conatructed Signeture ol Appllcent Dele <br /> � PUBLICWORKSDEPARTMENT W'ORK AUTHORIZED BV THIS PERMIT MUST BE uTARTED WITHIN <br /> 3200CedarStreet 1B0 DAYS OF DATE PERMIT IS ISSUE-D AND THEFEAFTEH IS TO <br /> Evarelt,WA B82C1 BE DILIGENTLY PURSUED TO COMPLETION. THIS PERM�T MAY BE <br /> Phone:259-8BI0 CANCELLED BY TME C!TY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAVS DURAI'ION. <br />