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�2 �Appuwtlon For Date _ 3-'5�99 <br /> � PIJBLIC WORKS PERII!IIT --� <br /> PUBLIC WORKS DEPARTME":T Public Works Permit k B <br /> 3200 Cedar Street <br /> Everetl,WA 98201 (425)257•8810 Building Pertnit& _ ' 61928 <br /> JUN 1 •": 200Q <br /> TYPE OR PRINT ONLY T� POSTI N G __�� Public Works Fee$ .�S�O _ <br /> 36 <br /> Roaen-Harbottle 1715 114th Ave SE 1f212 Bellevue 98004 425-454-3030 <br /> Owner Mailing AdCress �iry Zip Phor.e <br /> Connell Design Group Mel Maertz 425-670-6706 <br /> Applicant Mailing Address Ciry 21p Phone <br /> Describe Proposed Work addition to Washin ton Mutual Bank W <br /> � <br /> _.^ .r —I <br /> - ._ _. . _614�_'� � <br /> PROJECTADDRESS (ifknown) 5201 Evergreen vJay �;!_0 '4E9,95 <br /> ;;ii;ia'v �f.`0 O <br /> :� �-:S( ,y0 <br /> Attach four(4)copies plan;:for proposed work•Draw to scale eM note the fo�lowinq if applicable: - -,- � <br /> i.�1,�+_.r, ;:J.S;�� <br /> •Property Lines •Outline and dimensfons ol all axlstfng and proposed structures on the bt •EzisGng and propo,ed utiliuo5 .-. <br /> i1 . .... . _. <br /> •Ceotedine ol street •Indicate NoM •Show any proposed gradir g changes •Show measuremeMs -, .;� �,,: ; +., ��. <br /> DO NOT WRITE BELOW THIS LINE :;)i;�:_ 79,>2, =`_� Z <br /> PERMIT CONDITIONS: " ' <br /> .:�_ - �, � <br /> 1. All calis for inspection shall be made 24 hours in advance - phone (425) 257-8810 ' ' - <br /> 2. All work shall be performed in accordance with this permit and current City of Everett Design and � <br /> Construction Standards and Specifications.. <br /> 3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800-424-5555. ♦A <br /> ♦/♦ <br /> � /pe�re�v � Y'e-i�s�a.LLa�roti o�' �h� c�fc� �as:h . , � <br /> af �`ie Svv�-eaS� Corn�r o,�' �fhe �jv�Ldn� �e:r�re��s�a .a <br /> b�yih�h•,�y wo.�.E ah �ra ih�ti e Sys��. <br /> J� CQ{C�i �IS//7 /907'�2�cf'll�iLL 6e C/T� .T74*-hdar� '+� ¢O2. <br /> .1/IS'f2�� 94S '�/-tz� f�¢v' ,S�a�ir�q� #¢/11 Q.S" /'7P�c%C . <br /> ACKNOWLEDGEMENT OF CONUITIONS <br /> The undersigned oxr.er/applicant hereby egreas to Mld and save hartnless <br /> � l���,� ihe Ciry of Everett from any and all claims for damages,tosts,expenses,or <br /> pprove r o ruc io�7 a e causes of actlon that may adse beceuse of Installation end melnlenance of the <br /> / improvement or other rIg - ey use hereto applied for ana turther agrees to <br /> !�� `- �� �� remove same upon rw the City and to replace publb property dam- <br /> <c c-� aged thereby. <br /> FIIJAL INSPECTION Date <br /> Approved as Constructed <br /> gne n <br /> VVORKAUh10R�D BY 7HIS PERMR MUST BE STAFifED WfT}iIN 180 DAYS OF DATE PERMR IS ISSUED AND TFEF�tiF7ER IS 7013E DLI6EMLY Pl1RSUED i0 <br /> CDMFXETKNJ.THIS PERMR MAY BE CANCELLED BY T11E CfTY UPON NJY 5'TOPPK',E OF N�(ON hIS PHQECTOVER 90 DAYS DUW1710N. <br />