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.�,., . <br /> �e <br /> o�� ..._ 1 <br /> ��y�y Date�qy � ,�.o. <br /> ouoim Won�Parmn• <br /> ��� Application For emc Dso� • 37442 <br /> � PUBLIC W4RKS PERMIT P�����W���.�.. <br /> �� TOI�IPo� 2 <br /> Q leu soo�ias Gno S <br /> O H Print or Type Only e.�e�<s o�s t <br /> �i� <br /> QM�y� <br /> �y virpil a,for h aro nlvn.cn.. el ,a Everett 98201 259 0730 <br /> Owner Meiling Address CitY ZiP Phona <br /> �M Kearsey Conat. 6631 Norma Beach Rd Edmonds WA 98026 742-5888 <br /> ��A APPlicant Meilinp Adtlrese Cit <br /> Y 21P Phone <br /> �� DeacrlbeProposedWork _l6'u10' addi �.... � L. p }� „pra�p <br /> ! <br /> Project Add�ese pl known) 302 Alvecaon 81vd. � ��� <br /> � ! <br /> Attach lour(4)coplee ol plens lor propoaed work•Draw to aca�e and note the following ae applicable: � <br /> � PropertY Unee � , <br /> •Centerline ol slreet � <br /> •Outllne and dimenalons ol ell exislinp and • Indicele Notlh ! <br /> propoaed ef�ucturea on t�e lot •Show eny proposed gradinp changes � <br /> • Exlntlnp and proposed utilities • Show measurementa � <br /> DO NOT WRITE BELOW THIS LINE � � <br /> � �1 PERMITCONDITIONS O <br /> 1.All calla for Inepection ehell be mada 24 hre.In advance•phone 259�8810. <br /> ' ' 2.All work ehall be peAormed In accordence with thla permit and current City ol Everett Dealgn and Consiructlon ' <br /> Standarde and Speclliutlone. <br /> � 3.Call Locatlon Underp�oun0 9ervica 4H hra.before yuu dlg.TOLL FREE NUMBER 1•800�424•5355. <br /> � ; � ' <br /> 1-1 O <br /> 1 � � ' �.. <br /> �� U�'a' C��z/S��a'-�.�f,2��'��-u,��u•�/ �� � <br /> i' 1-1o=�z O <br /> _� a <br /> 0 <br /> �_ <br /> ACKNOW�EDGEMENT OF CONDITIONS <br /> '_' The untlarsigned ownar/epplicant herehy agreea to hold and save harm� � <br /> ' lesa Ihe City ol Everetl Irom any anA all cleims lor dama0es, cosls. ��. <br /> � expensas, or causea o� actian that may erise because of Installalion � � <br /> and muinlenance ol the improvemenl or other righl�o��wey use herelo <br /> applied for end lutlher agrees to remove same upon notice �wm Ihe <br /> Approvad br Contlructlon Date City and to replace public property damagetl therebµ � <br /> � <br /> i <br /> FINAL INSPECTION — � <br /> Date <br /> Approvad as Construcled Signature ol Applicant Date � <br /> PUE�LIC WORKS DEPARTMENT WORK AU7HORIZED BV THIS PERMIT MUST BE STARTEO WITHIN <br /> 32p)CedaiStreel 180 DAYS OF DATE PEFMIT IS ISSUED AND THEREAFTER IS i0 ' . <br /> EveietC WA9820t BE DILIGENTLY PURSUED TO COMPLETION.THIS PERMIT MAY BE I <br /> Phone:759�BB10 CANCELLED BV THE CITY UPON ANV STOPPAGE OF WORK ON THIS <br /> PRO.�F_T OVER 90 DAVS DUFATION. <br /> � <br /> 1 <br />