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�_ <br /> � <br /> ,1,,,.._ <br /> ., i <br /> . � <br /> ��� _ . . � r <br /> � � � . __ � <br /> �� .�: ��r� � <br /> � � � �1 Y� ' <br /> � �8t8 +z� �91 PueecWnrv.�Pe�mu• •/ ��7 <br /> aiec o���� . 91/35110 <br /> �_� APPliwtion For _ ... <br /> ^� PUBLIC W4RKS PERMIT "°°°`w°'"°`�° • <br /> ,o,.��« <br /> �+�� Q lefe�oP�Fee Fe•d S — . <br /> ��I G �00 <br /> Q� f� ' Bel�nte Due s�� <br /> Print or Type OnIY r <br /> �yt y� ,. ; ,; 007-3Z7- S/O-Oot'-//-�43� <br /> r � Radiology Assoc. r'382� Colbv Ave Everett 98201 258-3421 <br /> �� Owner Ipaflm$.(�ddress City Zin Phone <br /> �� i � <br /> n i .. ��i <br /> y� �-. .; , 259-3136 <br /> Bob Champion �;__� <br /> . � APGlicsnl MaiLng AAdress CitY Zip Phone <br /> DescribeProposedwork iT' Parking <br /> e I <br />; ; . _ W <br />� , <br />� -�'` : ' � 3d92- Colb Ave. � <br /> Proied Address(il known) <br />� � Attach fow(4)copies d plans lor proposeE wo�k- Draw to scale and note the loilowing as apPlicable�. � <br /> � • Properry Lines • Centerline of street ♦� <br />� • Outline and dimenslons ol all eristing and • Indicate Norih V� <br />� proposed structures on the lot • Show any proposed gratling changes <br /> .-=� • Ezisting and proposed utilities • Show measurements M � <br /> �>>+1 W � <br /> DO NOT WRIiE BCLO�'�'THIS LINE O <br /> ! PERMIT CONDITIONS <br /> � t.All calls for Inspection shell be mede 24 hrs.in advance�vnone 259-8810. � <br /> C� 2.All work sha�l be pertormed in acwrdance wilh this permit and current City ol EvereH Design and Consiruction <br /> Standerds and Specilications. <br /> 3.Call Location Underground Service 48 hrs.belore you dig.TOLL FREE NUMBER 1•800�424•5555. � <br /> r <br /> � t/f.�C �.(l0/`�C %O LC �OI7C �.:I� /�CQ/'1 �.)�J/'C���'c� �ii/ O �. <br /> .�` �� ' ' <br /> �/e PvG/:� l�oi-�= t�ef�1.- on /?-1.�-9/ (ec �f/c,:/,c�/> � <br />' � � �G �Gc ''�,�.nr-/ ��)� �✓'��%iC'[J �Y li��7/ i,�/,a L C� � <br />� � ��—� � r�f�,-,-�,�� ��-,,�1 , � <br /> i �— a <br /> � � �� <br /> �� ACKIJOWLEDGEA-0ENT OP CONDIT!ONS <br /> The undersigne0 owner/applicant hereby agrnes t�hold ana save harm- <br /> . less Ihe Ciry ol Everett Irom any and all claims ��r Aamages. costs. <br /> expences, or causes ot action ihal may anse Uecause ol installation <br /> � 1/��J'� �2�Zj�9� antl maintenance ol the Improvement or other righl�ol�way usc hcreto <br /> • � �pplied lor and Iurihor agrees te remove same upon notice f�om the <br /> Fpproved I Consiructi �' Date Gty and to replace public U'operty damaged thereby. <br /> � __��-,^� � �`�v��� (_/��f S �-�p�12 <br /> � FINAL INSPEGTION Date Dale <br /> �� n Vucted ignat re o �icant _ <br /> AnProved xs Co s <br /> � AUTHORIZED BY THIS PERMIT MUST 8E S AFiED \NI1HiN <br /> PUBLICWORKSDEPAFiTMENT 180 DAVS OP DATE PERMIT IS ISSUED AND TNEREAFTER IS TO <br /> -�,'1�:;{•.,���, � 3200 Cetlar Sireet BE DILIGENTIY PURSUED TO COMPLETION. THIS PERMIT MAY BH <br />� , Everet4 N/A 98201 CANC[LIED BY TNE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />� ?none:259�0810 PROJECT OVER 90 DAYS DURATION. <br />� <br />� :� __ <br />