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� � � <br />cu <br />H <br />� H N <br />y � Hn <br />� H �7 <br />O LC O <br />'q H nJ <br />y y <br />p �� <br />� H � <br />O H <br />G~1 � nc� <br />2 t+7 <br />� y z <br />N H <br />p y H <br />f� C N <br />`� ro r <br />a H N <br />H O tn <br />�� <br />I o ' <br />� � ��' <br />:,,�., <br />:, s . <br />:4Y�s� r <br />� 4.` . <br />Date 5�2��9` <br />_,y <br />... . . . . . 4x:��: ;".J*�i ^< . . <br />Application For <br />Rl1[iLIC WdRK� P�RI!lVIT <br />Print or Type Only <br />"i <br />Inol¢ woda Pcrmil • <br />em9. oeo�� = 36837 <br />IPubl¢ WorhS Feo <br />Tolol Fna � — <br />Less ROGL Fea P.+iE 5 <br />eaianca oue S . <br />Fl & Donna Pioli 5529 Lowell Rd Ever�tt 98?04 RS�i-0582 <br />Owner Mailing Address City ZiP Phone <br />Nalbach Const. 2132 Hiqhland Ave Everett 98201 252-7450 <br />Applicant Mailing Address Cily Zip Phone <br />Descri6e Proposed Work _S'��arF t f GFR <br />Proiect Address �il known) <br />Fttnch lour (4) copies of plans for proposed work - Drav� to scalz and nole lhe following as applicable: <br />• Property Lines • Centedine ot street <br />• Outline and dimensions of all existing and � Indicale North <br />pwposed structures on the lot • Show any proposed grading changes <br />• Ezisling and proposed utilities • Sho�.+� measurements <br />PERMIT CONDITIONS � <br />1. 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 currert Ciry of Everett Desiun and Cons1� icticn <br />Standards and Specilications. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1•800-424^�SFiS. <br />/V(� rU�J-�c-�' G.i[iP%� lJ,�,Zr,....11/�P �-'C)/7 <br />� ����'�/� � <br />//O V <br />S- ZI-/L <br />Approved lor Consiruction Date <br />FIIJAL INSPECTION <br />Approved as Constructed <br />PUBLIC WORKS DEPARTMENT <br />3200 Cedar S�reet <br />Everett WA 98201 <br />Phona 259�8010 <br />Date <br />:;_ <br />� <br />4 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undersi�netl owoer/applicant hereby agrees to hold and save harm- <br />less ihe Ciry ol Everett irom any and all claims lor damages, wsts, <br />ezpenses, or causes ol aclion that muy ari=e because of installalion <br />and main�enance ol the ;mprovp;nen! or other righ�-ol�way use here�o <br />applied for and luriher agr_es tn remova same upon notice Irom the <br />Ciry and to replace pubP:: Prepc;ty demagr.d thereby. <br />Signature ol Applicant Date <br />WORK AU1.10RIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLET�JN. THIS PERMIT MAY BE <br />CANCELI[D 6Y THE GITY UPON ANY STO°PAGE OF'NORK ON THIS <br />PflOJE-CT OVER 90 DAYS JURATION. <br />