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Date_1�11-92 <br />S-?1t-1.•�'- •�} <br />Aapllcaiion F_d <br />PUBLIC V!'G�3KS �E{�AiING �-21-9s <br />Print or ;yGe Only <br />l�merlcan Esta[es <br />Ownui <br />Owner <br />4312 127th P1 SB Everett 98: <br />Mailm� Adtlress Cdy <br />Maihng Atldress City <br />De�::nbfl F�oposuo Work _ new hruae <br />Projecl Address �il known� 33 - 113th St SE <br />-3188 <br />Zip <br />Attech lour (4) copies of plans loi propcs9d work � Oraw to scale =atl nole Ihe lollowing as apphcahle. <br />• Property Lines <br />• Oul6ne snd dimensions of all existing and <br />propoSeA struclures on the lOt <br />• Ezisting antl proposed utilities <br />,�„�,,,� wo,., ,,.,m,� . <br />�� �� _ <br />eina o�oi . . 38976 <br />PuG�¢ Wena Fm -- <br />Toiel ���. S __ <br />Leff Aptl fee Pe�tl S���}_.��� <br />B�ie�ceDue S_W <br />w Centerline ol sireel <br />11 Indicale North <br />• Show any pr�posed 4�radiny ,;hanges <br />• Show measurnmenL <br />Phone <br />PERMIT CONDITIONS <br />1. A�I calls for inspedlon shall bn matle 24 his. in eavence • phone 259•8810. <br />2. All work shall be pedormed ir accordence with this p�imil and curren; City ol Everett Desipn end Constructlon <br />Sianderds and Specilicatlons. <br />3. Call Locallon Underground Se�vlce 48 hra. belore you diq. 7'OLL FREE NUMBER 1•800•424•5555. <br />�'• G�II 3�j��'7t.�' �9i' PrG -C:OtlltYUc,t.���-� c�:nfrrc;nc:e.. <br />�'�G'�Z/. <br />PL'i�t�. �.yOP�:S f1EPANTMENT <br />3204 ;edar F�rer�. i <br />EvereB. WA ��0:.; � , <br />Phone�259�6B10 <br />ACKNOWLEf�GEMFNT OF CONDITIONS <br />r•1 <br />U <br />� <br />� <br />M <br />a <br />The unda�siynntl uwner/applicant here�y agrees lo hold nnd aace harm- <br />less Ihe Gly ol Evorell Irom any nnd all cla�ms lor damapos, cosls. <br />expenses. or caiises ol ar.lion Ihnl mny arise because ol mstalleGon <br />and mamlensncr, ol ihe improvement or olher righl�ol-w�y use hereto <br />aPP��eA br and �urther agrees to iemove same upon notice Irom Ihe <br />Ctly and lo rePlace Pubhc P�oPerty dam�ged Ihereby. <br />� i i <br />,��1'r'�'' �� �Yy. <br />Sign�turc ol ApPl�Can� Dale <br />WORK AUTIiOR'ZED BY THIS PERMIT MUST BE S7ARTED WITHIN <br />180 DAVS OF LATE PERMIT IS ISSl1ED AND THEREAFTER IS TO <br />9E DILIGENTLV PURSUED TO COMPL ETION. THIS PFRMIT MAY BE <br />CANCELLED BY THE CITV UP(1h ANV STOPPAGE OF 1VGRH ON THIS <br />PROJECT OVc'R 90 DAVS DUPAIION. <br />