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I <br /> 5� M <br /> C�1 <br /> A x <br /> Q H <br /> 9Hcn <br /> 4 <br /> H � <br /> tC C] <br /> H :U <br /> �y � � /,, <br /> � �oi� Date� � lU I>�`��,�,• Pu�licWo�FaPa�mil• �/3gs <br /> �/^n/on <br /> O H GJ P Application For � /��R Bie9�Dem •�0/25258 — <br /> �� g PU�.IC WORKS PERMIT ��� � � °°°;o„�oe�°° s <br /> 55 p0 <br /> 'ri H S O le=s 4nN Yce t'am 5 <br /> > y �� s g� �m v� � � S � o � ❑.,�.���,�.n,��• 5 Z� — <br /> t" N y Print or Type Only a <br /> �y (� .rOON �tO lil O G[� M <br /> {J y H M M N N p � � �~il � N�R M � <br /> ��y [� .y v. <br /> r T. Tim Dfil � 4 - t t � Lvnnwood 98C37 742-1427 <br /> �ej Owner � P1 A il � �+ � ]�' Gty Zip PhonC <br /> y � y sea crest flanes �sa�cn� a�s a'b'ov�e� � � � � `� � <br /> AFPlicant Mlailing Address Cily :�p Phom. <br /> D�:scribe Proposed work New single family residence <br /> � <br /> FrojectAtltlresslifknown� Lot 2 - Wltite Cli£fs of Dover 7803 ^ ENC'�l-P"uf� rn\/E � <br /> A!:ach lour(4�copies of plans for proposed work- Draw lo scale and note Ihe lollowing as applicable�. � <br /> • Pwperty Lines • Centerline ol street ♦^ . <br /> • Outline and dimensions of all exislin9 and • �ndicate �orih V� <br /> pmposed structures an the�ot • Shov:any Proposed gridin�changes <br /> " • Existing and proposed utilities • SY,ov:raeasuremeNs �A <br /> 1�' DO NOT WRITE BELOW THIS LINE O <br /> '�1 PERMIT CONDITIONS <br /> t.All calls lor inspaclion shall be made 24 hrs.in ativance-phone 259•8810. � <br /> 2.All work shall be peAormed in accordance wilh this permit>nd wrrent City ot E��erett Design antl Construction <br /> '�' Standards and Speciliwtions. <br /> 3.Call Location Underq�ound Service 48 hrs.belore you dig.TOLL FREE NUMBER 1-800•424-5555. � <br /> i ; 4V. A���.� L�.,V'r sNp-�-`-- ��-lo�T E�c�ST� UC-� i��i�c�v.�; O <br /> � ,4P��J E I TJsTy'``�. NE.��/ �`'��- �lr�L�T CSJ�Z6, C-��7'iTE7"� `� <br /> �' � S���/s�L�� .�s �QZ ST.O �A.tiIS 3oS �3�0 • l � <br /> �' io , A('"�1Gi�)T SNAI_l_ I IJSTFkc�_ NE�V l-'7- 2�V�orti( /�-P2cN ♦/� <br /> � �/♦ <br /> I 1 C�,��, �K� �.�� � - zo�� � �� 5� �,��o--� . � <br /> �=1 � <br /> ►' <br /> _�- <br /> ACFNOWLEDGGL1ENi OF CONOIT�ONS <br /> (V' The unC^rsi9��od owneUaUPlicant hcrebya9rees to hold and save hornr <br /> — less Ihe Gty of Everetl Irom any and all claims for dam:�9es. costs. <br /> expenses, or causes ol aclion Ihat may arise heaause o' insWllation - <br /> G 1nn� Q _s�� and mamtenance of the Impwvement or other n9hl�nbwa� use hereto <br /> roc. � � , ��:� apPlietl lor and lurther a9rees lo remove same upon noticc Irom Ihe <br /> ApP�ov��d tor Conslruct'on ���e Ciry antl to reF�ace public properry damaged thereby. <br /> ����� f�-9� � . <br /> . � <br /> FINALINSPEGfION Date � <br /> 1 � �J <br /> Approved ac C^n�:iructed Signature ol Ap IicaN � Date <br /> - WORK AUTHORIZEO BY TNIS FERMIT MUST BE STARTED WITHIN <br /> ivtrcll PUBLICWORKSDEPARTMENT 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � 'f200CodarStrect BE DILIGENTLV PURSUED TO COMPLETION.THIS PERMI7 MAY B[ <br /> Everot4 WA9B201 CANCELLED BY THE CITY UPON ANV STOPPAGE OF WORK ON THIS <br /> ?hane:259�0810 PROJECT OVER 90 DAYS DURATION. <br />