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Date�11L39/94 , � Y � ` 38(� <br /> Z� � Pu011C WprM�Parmll• / <br /> • � ApplitatlonFor �wa� $5 aiao.oeoi.. 4633G <br /> n <br /> • PUB � WORKS �.�RMIT Pu011cWorkeFee <br /> \ r � Total Fae s <br /> � \�� (�TO POSTING ����`�'�� LeseAoOLFeePaiC S� <br /> Print or Type Only q �f ` r+ n � o v �? ,n � c� e�ia�ceo�e S <br /> r_ �i c: o :.� u i.� i i, <br /> � <br /> � �i» "i � � �w � NCJ � <br /> �F 'u�� ul M +r+ y� � �J <br /> N e1 Y! .+ <br /> Pe:�r Reincke Inc 12414 40eh Ave S:: 98'208 388-577'!� "` <br /> Owner Mailing Atldressn �. � C�ryj � ,Y �� ti Zip Phone � <br /> � 0 �3 � u `L�i u ... �, '!�. c7� w <br /> S`3�1e p �J ../ : 1 ,.y! rf " (;] i �- <br /> CV T �� :L t: l� J� .�l 'Y '(' l0 !�1 <br /> Applicant Mailing Address CIIy Zip Phone <br /> New house <br /> Describe Proposed Work � i , i•� • <br /> '� , : <br /> •�� g . _. <br /> �i , � . _. .._. .. . j ;: <br /> --=� ��_�I�;'1;• ��'1' — <br /> . , <br /> ...�i'r;...^^.....:............... �1 <br /> Pro�ect Address(il known) 2 ��✓Y�i'IU � p(,Q� �t 1��$1�P.�5gn89��',,.' � <br /> Attach four(4) copies of plans for proposed work- Draw to scale and note the tollowing as applicable: � <br /> ' • Propehy Lines • Centerline of street � <br /> • Outline and dimensions of all existing ard • Indicate North <br /> proposed structures on the lot ��� Sliow any proposed grading changes <br /> • Ezisting and proposed Wilities � Shaw measurements � <br /> DO NOT WRITE BELOW THIS LINE <br /> PERMIT CONDITIONS O <br /> 1.All calls for inspectbn shall be mede 24 hrs.in advance-phone 259�881 O. ' � <br /> 2.All work shall be peAormed in eccordance with this permit and curtent Ciry ot Everett Design and Construction <br /> Stendards end Speci(icationa <br /> 3.Cell Lxation Underground Service 48 hrs.before you dtg.TOLL FREE NUMBER 1•800-4245555. � <br /> -! Ri�;�i#.�p :1C.JIl:I(�L'' :;hali b: LIIJVhargel: <br /> . i J .il� .iit��3 .ii��,ilii i�i:wl a�"��.11l i E7i1'iii(l or pnbli�� O <br /> • Tu .l Lo,ti�cllG��2 iui�f iivW il�l,'i.�:ll ,'YaicU? t�ri1�.I1Ci1 �1c( �c�llc��i �- <br /> 9 -4 uf ili� ciiv �:isunio-ttds � <br /> • �_�nro �!+l��ch bl��cK.; � <br /> I h� tllNlll�-�il seie�rrii w�l� i)? .11�)�!'i:S !O f'Ut)�iC 44•�rKs i�e;artement O <br /> ��pnro�•sl. <br /> a <br /> - , <br /> ACKNOWLEDGEMENT OF C�NDITIONS <br /> r <br /> �' The undersigned owner/applicant hereby agrees lo hotd and save harm• <br /> less Ihe City ol Everett Irom eny and all claims for damages, costs, <br /> � / nnn...��� ezpenses, or causes ol action that may arise because of instaltation <br /> � � �� /� [� /Z v ycs.. and maintenance ol the improvement or other right-ol•way use hereto <br /> � � applied lor and lurther agrees to remove same upon notice Irom the <br /> Approved Icr Construction.-, Date C�and to replace pubiic properry damaged thereby. <br /> / y '� ) \ / <br /> �' „ , � . <br /> � �- S�- //-J' j ,��✓; �/ �� • � <br /> FINAL INSPECTION Date <br /> Approved as Constructed gn lure ot Applicant Date <br /> � PUBLIC WORKS DEPARTMENT RK AUTHORIZED BY THIS PERMIT MUST BE J7ARTED WITHIN <br /> 3200CedarSveet 780 DAYS OF DATE PEHNIT IS ISSUED AND THEHEAFTER IS TO <br /> Everetf,WA�38201 BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Phone:259�8810 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Pf70JECT OVER 90 DAYS DURATION. <br />