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� <br /> 2/23/95 '% , �j <br /> Date P�e���wo,k.Pe,m��. `. 's- � <br /> Applicatlon For � eiay.oeo�.• 47f150 � <br /> r,� <br /> PUBLIC WORKS PERMI�' P�s'�cWorMSFee <br /> Tolal Fen s <br /> C� LessAODI.FeBPa�E S <br />' �� �:O� e <br /> Print or Typa Only �� BaianceDue S 7�� <br /> GO O fj <br /> U ut O In C/ ryn1 <br /> ��I P Y� l" � —'� '- JC� 'S.J� ,I ''��� <br /> ��:I ti ✓c . . p i��'7G —,i . � i � r <br /> --t M H f� <br /> Art Skotdal PO Box 5267 Evexett 98206 2Sg-43S�i � <br /> � <br /> Owner Mailing Atltlress �� ��ty �n � 2ip Phone <br /> ��i nc� i o � r� <br /> b p0 � OO �.T = <br /> Y�> X, Gl V1 SC 6 (_1 <br />.. ApP��caM Mailing Address City Zip Phone <br /> Describe Proposed work Reface building <br />� }'�� f/✓S�?Ai:C ��C.lcn�' �'nC�' lJi�.� /�z�-,E t ci.•� ' ` <br /> , / � �. �'s. 'h C7 �o <br /> 'i` P=�,f,T �i7• lL: <br /> �;, � Projec�Address�ifknown) 2929 Colbv Ave T//��S ���C ��cY;+ � I <br />� � Attach lour(4)copies of plans lor proposed work• Draw to scale ana note the tollowing as apPlicable: � � <br />� ' • Property Lines • Centerline of streel � '� <br />�� •. • Outline and dimensions ol all existing and • Indicate Norih <br /> i - proposed structures on Ihe Iot • Show any proposed grading changes <br /> • Existing and proposed utililies • Show measurements � <br /> IDO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 1.All calls for inspection shall be made 24 hrs.in advance•phone 259•881 O. � <br /> 2.All work shall be peAormed in accordance with this permit and current City of Everetl Design and Construction <br /> Standards and Specilications. <br /> 3.Call Location Underground Service 48 hrs.before you dig.TOLL PREE NUMBER 1•800•424•5555. � <br /> / - . <br /> Y: 1,,���� w �.�,.�,�,.,, �{' �f ��,��I -�'-,- �- � <br /> CLaar fa tunik �.zlo.�y Si,�i✓a .!E , <br /> � � <br /> s �tiy �4�,��� �� ��� s���v���� s�;,: �� �� � <br /> ic�.«-�,�/�znl„��•�1 �j l�;� ��,j.r';� .� „ � <br /> . Q <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees to hold and save harm� <br /> less the City of Everett from any and all claims for damages. cosls. <br /> ezpenses. or causes ol action ihal may arise because ol installation <br /> `� �3 J and maintenance ol Ihe improvement or other righl�ot�way use hereto <br /> applied for and lurther agrees to remove same upon notice Irom the <br /> Ap ed f on ��ction � Date Ciry and ro replace public property dam ed Ihereby. <br /> ��� � �,�,�,y/ <br /> FINAL INS�CTIOM Date � �iv/ <br /> Approved as Con;iruded Signature ol Applicant Dale <br /> ������ PUBLIC WORKS DEPARTMENT WORK AUTHORIZED BY THIS PEfiM1T MUST 8E STARTED WITHIN <br /> 3200CedarStreel 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everett,WA 98201 BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Phone:259�8870 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER�30 DAYS DURATION. <br />