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i <br /> � F 1-z.8-4 ��� � - <br /> �Date 9-5-91 puni,cwaitePnimn. �i�.--- <br /> ' Applica�ion For <br /> TQ P(1�T'^��' APR 0 9 2006 Biaq 0eo1 • 91/z��so _ <br /> �� PUBLIC VNORKS PERMIT ����- °°°'�°,°°��„°° -- <br /> To�a�Fae S <br /> �essnnoi Fenra�a $ <br /> ��) -- <br /> '� �'� � � Balancn D�m 5 � -- <br /> Pnnt or Type Only ' <br /> - - . � <br /> I �; �, <br /> r <br /> Rod Nicholas 16000 Mill �Yk Blvd #110 . , Mill Creek 98012 337-6611 <br /> Owner MaitingAddreke..: " }-i Gty ;!} _;.. -- Zip Phone <br /> r'. i� 'i .. i�l r i :L �i� a [J <br /> � �i 1��: i (.1 Iq '.. lil <br /> .I '..I lil [v' .1. <br /> i - r "� ��. -x_ r,� o r_� 337-4733 <br /> curt Johnson ' <br /> Applieant Mailing AddresS City Zip Phone <br /> Descri6e Proposed Work new construction duplex _ <br /> At3 ) �� � <br /> Project Address lif known) ���� � ���\VOt.JL /-�V�V�V� � �-0-(� -3 � <br /> Attach lour(4) copies ol plans lor proposed work� Oraw to scale and note Ihe lollowing as applicable: � <br /> • Properry Lines • Cenlerline ol street � <br /> • Outlinc and dimensions ol all enisting and • Indicale North <br /> proposed structures on the lot • Show any proposed grading changes <br /> • Existing and proposed utilities • Show measurements � <br /> DO NOT WRITE BELOW ThiIS LINE O <br /> f'ERMIT CONDITIONS <br /> t.All calls for inspection shall be made 24 hrs.in advance•phone 259-8810. � <br /> 2.All work shall be pedormed in accordance with this permit and current City ol Everett Design and Consiruction <br /> Standards and Specifications. <br /> 3.Call Localion Underground Service 48 hrs.before you�fig.TOLL FREE NUMBER 1-800•424-5555. � <br /> ��, I � r��\ �:J1 �•t{ .� 1 � r00���= 1 �LIL Cl.^;V-C\v3�� �� r' r'�.'�0."I.C 'lv O <br /> � <br /> 0 <br /> �i 1 � �y � <br /> `-.�_�`�`��1 . . ��'�a �� �CV'� l�l�� ���.�. :�1��/�,� � �ti � �� <br /> �w <br /> _I <br /> O <br /> a <br /> ( ACKNOWLEDGE�dENT OF CONDITIONS <br /> ��(�� The undersigned owner/appli[an�hereby agrees to hold and save harm� <br /> -1 tess �he City of Everett Irom any and all claims lor damages. cosls. <br /> _� expenses, or causes ol action Ihat may anse �ecause of installation <br /> �I./�C /^ , � and mainterR�ncc of We improvemenl or other righbof-way use hereto <br /> � �F �� � 1 l� � �v— ��� � appliod�for nnd fiirther agrees to remove same upor. notice from the <br /> Ap�-��rved lor Cons ction Date City�and tdreplacc public properry damac�ed thereby. <br /> �" / • <br /> /'����'.f�. —� ,� -� �a - ) Z ��� ,.. ' ,'�,� -- <br /> , / , _ <br /> FINAL INSPECTION Date " <br /> A�proved as Constructed � �Si9npti re of Applicant Date <br /> �� PUBLICWORKSDEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> � 3200GeoarStreel 160 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everett,WA 9�2ot BE DILIGENTLY PURSUFD TO COMPLETION. THIS PERMIT MAY BE <br /> ��/ Phone:259�9810 CANCELLED BV THE GTY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAYS DURATION. <br />