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Date 12-15-92 <br />Appllcation For <br />PUBLIC WORKS PERMI� <br />i <br />Print or Type Only <br />PuEI1C Worh� Perm11 • • � `� � / <br />Bldp. Dso�. • 39005 <br />PuElk Wod� fe� <br />Tm�i q� f <br />Len Apo� Fo P�IE s <br />. .., . B�bnn Due'.. , s z� o0 <br />Bill Guetaveon PO Rox 2702� Lynnwood WA 98036 78d-6920 <br />Owner Mallinp Addreas � . , City �� � � � � Zip � � Phune <br />Owner - . . . . . <br />Applican� Malling Addiess City Zip Phone <br />Descrlbe Proposed Work new <br />Pro�ect Adtlrese (II known) <br />r� <br />Attach lour (4) copies ol plans lor proposed work • Draw to acale and note Ihe lollowing as applicable: <br />• Property Llnes <br />• Oulline flnd dimeneions ol ell existing and <br />R; �posed slructu�ea on the lot <br />• Existing and proposed utllitiea <br />• Centerline ol street <br />• Indlcele North <br />• Show eny yioposed grading changes <br />• Show meesuremenls <br />PERMIT CONDITIONS <br />1. All caile lor Inspection ahall be mede 24 hra. In edvance - phone 259•8870. <br />2. All work ehall be perlormed In eccordanca with thle permlt and current Clty ol Everett �eaign and Conalruction <br />Stendarda end Specilicatlona. <br />3. Cell Locetlon Underaround Service 48 hra, belore you dlp. TOLL FREE NUMBER 1•800-424•5555. <br />� �:.�4.a.�r-� �., � �4.o�r� fJ'tct/Cwa.y .Lo 7r.vl �.o ,lirn�ecGr <br />!J (/ <br />4 �oc.,.�.�.•.� �09vPc�,7`.c%�. oz (��y .P��f -o{� a/ay. cQ�w�.�'.ee�� <br />�l S�cL.+. a�.. �,(�i„�. 'Y+'�ay 'rs� � c�4o�nts� � CQn.GscE�� <br />C✓z.YiG �1u-l+�'.G cvozl�d. .i.+.,y�1eO�-Z`�rn. �,.e�.p� t�,.aQr;.,y., <br />o U <br />�1o�k co��(e��l ��, w��� be'�I�wol la� <br />�/�� ��'Joc—/ _ %�j%j <br />Approved lor Construction Date <br />FINAL INSPECTION Dale <br />Approved es Conslrucled <br />�Ar�PUBUC WORKS OEPARTMENT <br />3200 Ceder5lreet <br />Everell, WA BB201 <br />Phone: 259�BB10 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />W <br />� <br />� <br />The undersigned owner/epplicant hereby agrees to hold and seve harm• <br />less Ihe City of Everetl Irom eny end all cleima lor demeges, costs, <br />ez�enses, or causes ol actian thet mey erlse becauae ol Installetlon <br />end mainlenance ol the Improvement or other right•ol•wey use hereto <br />epplied lor end lurther egreea lo remove same upon notice Irom the <br />CJ{' y.8`d to replace publi�roperly�d�rfaged thereby. <br />Si¢nature ol Applicanl - Dnte <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />1B0 DAYS OF DATE PERMIT IS ISSUEO AND THEREAFTER IS TO <br />8E DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BV THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />