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Date 9�30/91 <br />Appllcetlon For <br />PIJBLIC WORKS PERMIT <br />Print or Type Only <br />1�-2 y-28-S <br />TO PQSTING�:_�� <br />PUEI¢WorF�Permll• `�1 �e5'__ <br />BIEp Deol • oi ��6922 - -- <br />PVEIr. Wo�k� fea ---_' <br />Tol�l Fee � <br />Le���oo� �aePUE i <br />eehnca �ue i ZD _ <br />William P Gr����. PO Box 660 Everg� 48206 258-�5a <br />Owner Malling Adtlress City Zip Phone <br />Owner <br />Applicant MaIIIngAddress Gty Zip Phone <br />Deecribe Propoeed Work __ House move from 1119 - 1G4th St <br />Prolect Addresa 111 known� 2132 - 116th ST SE <br />Attach lour (4) copiea of plens lor propoaed work - Draw lo scale end nole Ihe lollowing es eppl.ceble: <br />• PropartY Lines • Centerlina ol slrael <br />• OuNlne nnd dimenelons ol all exletlnp a�d • Indicata North <br />p�opoae i Btrudu�ae on the lot r Shovi eny propoeed grading chenges <br />• ExistlnB and proposed utllitles • ShoN ineeauremenls <br />PERMIT �ONDITIONS <br />1. All cells lor Inepectlon ehell be made 24 hre. In advence • phone 259•8810. <br />2. All woik ahell be peAormed In eccordance wl!h thle permll and �:urrent City al Everett Design and Conetructlan <br />Stend-vda end Speclllcetlone. <br />3. Cell L��cetlon Underpround Servlce 48 hre. before you dig. TCLL FREE NUMBER 1•800-424-5555. <br />��;��. <br />9. :,ha►� Pav2�f�M Pro�e,-L-� 1 �he -6o ed9�o{�t►-c,�t, <br />� <br />--��. M�K� 5-�-s1 <br />Approve onatructle , Dete <br />FINAL INSPECTI9N // � <br />Approved as Con.fliuctad <br />�PUBLIC WORKS DEPARTMENT <br />32U0 Ceder Straet <br />Eve relt, WA 8820'. <br />Phtne:259�BB10 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />W <br />� <br />� <br />z <br />� <br />� <br />� <br />� <br />a <br />The undersigned owner/epplicent hereby egrees to hold end save harm- <br />lesa ihe Cily ol Everelt Irom eny end pll clalms lo� damage& cosis. <br />erpenses, or ceuses o� ectlon fhet may erisa because of Inetullallon <br />end maintenence ol the impro�amenl or olher riphFobwey use hereto <br />epplied for and lurihar agreas to ramove same upon nolice Irom the <br />City end to replace publlc proparty damaged thereby. <br />-� � / � -`i/ <br />Signaturn ol App icent Dele <br />WORK AUTHORIZED BV THIS PERMIT MUST BE STARTED WITfiIN <br />180 DAYS OF DATE PERMIT Ig ISSUED AND THEREAFTEH IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAV BE <br />CANCELLED BV THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAVS DURATION. <br />