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Date <br /> APPlkatic� ��r l� VuElb Wotl4 Pnmtl� - <br /> PUBLIC WORICS PERMIT ���� <br /> P�Wonu FM <br /> Ta�l FN f�- <br /> Print or Type Only ����FN Mq �- <br /> B�4nq Dw f <br /> . �� <br /> Plan Check Nos H 27718 <br /> Owner Applicat.D�t�s 09/13/91 <br /> 3ob Addrp�: 1100 pACIFIC AVg <br /> S�pa Numblii ip Phone <br /> Propo�ad���: Hgp��, O lIC6 JOINT PHYS <br /> Appliunt De�c. of Norks <br /> T.I. �p <br /> Phone <br /> Describe Propoaed Work _ <br /> OFFICB SST JOB S6T <br /> APPROVED FOR PBIINITs DATB_I_I� BY <br /> Projact AAdro���if known� � � � <br /> At4ch four(4)coDiea of plens for proposed work-Draw to acale antl note the following as applipble: � <br /> • Property Lines <br /> •Outlins and dimenslons of ell existinq and • Centerline of street � <br /> proposad atructurcs on the lot � ��4icate North � <br /> • Exittinp en0 propotsA utilitlea � Sh�w a�Y Droposed g�adinq changes <br /> � Show measuroments <br /> DO NOT Wq�7E BELOW TMIS LINE m <br /> PERMIT CONDI710NS O <br /> 1.All qllt for inspeo}ion�hall be maCe 24 hn,in advence•Phone ZS0�8$10. <br /> 2.All wprk M�II bs peAormeC In accortl�nce wiM this permit anE currsnt City o}Everett Deaign and Conatruction <br /> $1�nCard�anC SPecHiGtIOnL � <br /> 3.Call�p�;�ryp����ro��d�ry�ce�B hre.beforo you diq.TOLL FREE NUMSEq 1•BOp•4y4.sb5b. <br /> �vlil�c �v�rzL>z /�_,eo,�� �� _ � <br /> f . �`�g�<.�„� � <br /> .� � <br /> �-�7�/ � <br /> � <br /> a <br /> ACKNOWLEDGEMENi OF CONDI710N5 <br /> The undaroigned owner/applicant hereby agreee to hold anC aave harm- <br /> leen the City of Everett from any ena all cleims for tlamagea, costa, <br /> expeneea, or c�usee of actlon thet may ariae because of Instelletion <br /> en0 maintenence ol the improvement or uther righhof•way use hereto <br /> �PProveE�or Conatructlon epplleC for and furthar agrees to remove seme upon notlee from the <br /> Date City and to replace public property AemegeC thereby. <br /> 'INAL IN3PECTION <br /> �PP�wroE u Con�tructe0 Date <br /> Siqnature of Applicant <br /> PUBLIC WORK3 DEPAqTMEN7 WOFK AUTHORI2ED BV THIS PERMIT MUSt 8E SiARTED WITHIN <br /> 3200CaG�g�r� 180 DAVS OF DATE PERMIT IS ISSUED AND 7'HEREAFTEq IS �TO <br /> E��'w��201 8E DILIGENTLY pURSUED TO COMPLETION. THIS PERMI7 MAY BE <br /> Phone:259�8E70 CANCELLED BY THE CITV UPON ANY 5?OPPAGE OF WpRK ON THIS <br /> PROJECT OVER g0 DAVS DURATION. <br />