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�8t8 1 LJ �� -a � �� —��_� puEl�c Worx�Permil� –4v O — _/ <br /> ` 61Ep Dept . C46832 __ <br /> Applicetlon For �� <br /> PUBUC WORKS P���t�fiING � - � i-`�� Pum�cWo.w�vee �_ <br /> Tulel Fee <br /> f,.l Lel��pDl iClPlb a <br /> r� <br /> Print or Type Onty u_ ,`,'i ,� 'f_', r�-', ;; g g F3 e.�.��eo�e a ?-d� _ <br /> '� � � �R „ " M � w <br /> r � <br /> Jacobsen l.en S Fran PO Box 2523 Evere�t 98203 38'J-6421 <br /> Owner Meiling Atldress � � 3 Cily 4 = �- „Lp Phone <br /> in o �? 4� -cc� x � �� i� <br /> . o �.i �oi.ar.Sc� F+ «iw <br /> Owner � Ye ��{ n �� t.� i`fi c'i . Gj = <br /> Applicent Mailing Add�ess City 2ip Phone <br /> Describe Proposed Work New house <br /> Project Address�il known� 22Z�' _SI��-�—"^�`d �� Lota 70-72 Blk 460 lln O� <br /> Attach four�41 coPies OI Olans lor proposed work- Drew lo scale and note the lollowing as epplicable: � <br /> • Proper�y Lines • Centerline af street � <br /> • Outllne and dimensions of ell existing antl • Indicale Nar�h <br /> proposed struclures o�the lot • Show eny proposed greding chenges <br /> • E�isting and proposed utlli�ies • Shaw measurements � <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 1.All calls lor inapection shell be made 24 hre.in advance-phone 2b9•8810. � <br /> 2.All work ahell be Ferlormed In accordance wllh thls permit end cu�rent City ol Everett Dealpn end Conetructlon <br /> Stenderda and Speclllcallons. <br /> 3.Call Laetion Underground Servlce 48 hrs.belore you dlg.TOLL FREE NUMBER 1•800-424-5b55. � <br /> G1 � brokar G✓d�M� wrb yvffr-s v�,s,El�w�hC ��� fx O <br /> 1 /�iMOtAlL' 4Y1d��7�G�G�I�f. '�ta G�lY7f6�7v/7 at'LIG /►'� ��5��-�+7. <br /> j �.,,�c�� ��s�� �srd�se�✓. N <br /> � <br /> � <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> 7he undersigned owner/eppllcant hereUy agrees to hold and sa¢c ha�m� <br /> --� - - - � -- --- less �he Gly ot Eve�ett Irom eny antl all claims lor damnges cosls <br /> � ezpenses, or ceuses ol ection that may eiise because ol inslanat�on <br /> 7, and main�enance ol �he improvement or other rlghbof�way use her,•t.� <br /> ��� applleA fo� end lurlher agiees lo remove same upon nMice Irnm Inr <br /> F�� ,,�,,,��,,, ��,�,.,� ,,�„��� Dale City and lo replace pub6c property dameged thereby <br /> %/ <br /> S/, <br /> i <br /> ��+' /'`... �`'-//- 9/ <br /> _ _ _ a-1_s-95 <br /> IiNFI W419 �,II�d1 DAte -------- ���, . <br /> F�q.�,iic�l :e: f.i,r�;lr���.lnrl SiAnalure ol AP{ 'ant <br /> ���J'�i Pi1HiP.Y/r�I�YhDIPARfMISNT WORh AUTHO Z[D BY TNI51`ff1A111 AIUtiI'11 vTaliiCl� 1Ut�. � <br /> 1B0 DAVS OF DATE PERMIT IS ItiSUI l ANf 111i 1�1 d1111: �< ' <br /> :V� ':7�/��.nilar hlmnl t3[ pILIGCNTI Y PURSUCII lll l'I�AfI`l 1 11i�N 11115 Pt ��4�It \�a� 7�; <br /> ~ � i ra�nu.V/F tiN7Ui CANq I l I.II(tl' IIIC CII\' UP11N �N1 1;1��1'1`q�H �`� \\.��t� ,`\ '•• t; <br /> I,i�,i�n :r,!�yyl�� I'N(7.11 CI 11Vl H!lu IlA\t: I�UHAl1��N <br />