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ii <br /> �� <br /> n <br /> / <br /> Zo)`l.�- �� -Z3�{- n.� / <br /> -���/91 � a�oi�c wo�xs cc��a. ��.�l.�C--� <br /> Date ' � <br /> � � • ema.oeo�.• 28176 _ . <br /> Application For <br /> PUBLIC �+'VORKSPERMIT '°°""'°"„`° S -- - <br /> Total Fee <br /> 1p �n«I��G_ �-��'�L Lrs:Aonlfaeial ^J <br /> xr� — - �a�,�,,,,��� s ?A—' <br /> Print or Type Only <br /> Ci1ay . . � . . . . . , ,. <br /> .ozx <br /> �' H <br /> a y� Creekside Custom Homes 10121 Cverereen Wy I'107 Pv�r�rt 9R704 'i94-9757 <br /> y9H — Mailin9Address �� Cny . Zm Phone , <br /> � Owner " <br /> � H� Piark PlcKenzie 334-9757 or Brent Daldwin ' 337-8069 <br /> �H qpplicant Mailing Address Ciry 7_ip Phone <br /> � z3[s1 New SFR 1168sf living / 440 sf gar LO"(— z <br /> y d Describe Proposed Work <br /> O H <br /> � oa <br /> r, n o <br /> c�� o <br /> r ~� Projecl Address(if known) 1 �Z '�"'� — ���'`� �"• � <br /> t7 N <br /> O H � <br /> O t7� Attach lour(4)copies of p�ans for proposed work-Draw to scale and note ihe lollowing as applicable: <br /> � �r • Properry Lines • Genterline ot stree� ♦^ <br /> z y N • Outline and dimensions of all existing and • Indicate North V� <br /> y �� proposed structures on the lot • Show any p�oposed gratlin9 changes <br /> • Existing and proposed u�ilities O Show measurements � <br /> - DO NOT WRITE BELOW THIS LINE � <br /> PEPiAIT CONDIlIONS <br /> 1.All calls for inspection shall be made 24 hrs.in advance-phone 259•8870. <br /> 2.All work chall be pedormed in accordance with ihis permit and current Ciry ol Everett Design and Construction � <br /> �, ,� Standards and Specifications. <br /> 3.Call Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1•b�^.O•424•5555. � i <br /> ' � �, M�S 1 PfZOV 1 DL �- O h F ST�L�i� T�IZKI t-�Gi „�`i 1k��S � <br /> .�., � � <br /> ' i <br /> � � i <br /> � I <br /> „� � Y• <br /> 0 <br /> � _,_'i � <br /> � <br /> ; <br /> � �� <br /> '����� ' ACKNOWLEDGEMENTOFCONDITIONS I <br /> (;. ;- �/fz The undersigneJ owneqapplicant hereby agrees to hold and save harm� <br /> "� �� 1 less Ihe City of Everelt Irom any and all claims for damages. costs, <br /> i8 � ^ eapenses, or causes of aclion ihat mav arise because ol installation <br /> ��1�1�`� � .. '��9Z and maintenance of Ihe improvemen� or other righPOFway use here�o <br /> �� applied for and turth ac�rees to remove same upon notice irom the <br /> Approved for Vuction ,. � Date Cily and b repl ublic proper� ed ihere6y. � <br /> ��� � �j C <br /> / ' � � � .. �/�/ �' ��C1 I <br /> �.,� y � �/ � <br /> RNA-INS�I�N - Date Oate <br /> Approved as Cons�ructetl� Si,�nature ol Ap icani <br /> `�e�/� WORK AUTHO IZED BY i5 PE M UST BE STARTED WITHIN <br /> PUBLICWORKSDEPARTMENT �ga DAYS OF DATE PERMIT IS I D ND THEREAFTER IS TO � <br /> � 9200 Cedar Slreet BE �ILIGENTLY PURSUEO TO COMPLETION.THIS PERMIT IdAY BE � <br /> � Everett,WA 98201 I CANCELLED BY THE CITY UPON ANY SiOPPAGE OF WORK ON THIS <br /> Phona 25��8010 �i pROJECT OVER 00 DAVS DUFATIUN. <br /> F ' -"t �.F'' <br /> � <br /> �,y�{� .� -- -- - _ . ._:�-.,,,,^•-.�—a^ "ti� -�''�MI.w�°'�''� � t�e� � � X'�n . Sa.. <br /> .� =xx:�?'�x = <br /> � �'� ir✓_'� �� -�. <br /> ,.,kie�tw mm� ...., . _ ...� .> �..,_.._ . _ _ . <br />