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� <br /> _:..r.�. . .. � �___��..�.... . . . _ � . ._rc' . <br /> 1 <br /> Date. 11�2z�93 <br /> TO �1,±?I�tVl7 � V���I a�ei�wo,k:P�,mn. 7.� S '; <br /> AppliCation For ;� emq oept: 4Z�7 <br /> PUBLIC WORKS PERMIT - <br /> PueLc Wo,ks Fcc <br /> To�ai Fce $ <br /> -� <br /> Print or T Q L¢ssApp� Fee P�itl $�- <br /> YP Only Balan�eDue � ,Zti°�_ <br /> John RoUinett 1831 Colb Ave Everett 98201 252-2500 <br /> Owner <br /> Mailing q�dress <br /> Ci�y c'ip _ <br /> Phone <br /> Owner <br /> APpliCanl Mailing qddress <br /> City Zip <br /> Phone <br /> Describe Proposed Work Ne4� 17ouse <br /> ProjeclAddress(ifknown) �7�L� — /Fj� t�•���� ���� W <br /> Atlach lour(4) copies ol plans for proposed work- Draw to scale and note the following;,s applicable: � <br /> • Property Lines <br /> • Oulline and dimensions of all exisling and � Centerline of street � <br /> p�oposed structures on the Int � Indicate North /� <br /> • Eaisting and uroposed u�ilities � Show any prnposed grad�ng chan�es V� <br /> • Show measurements <br /> DO NOT WRITE BELOW THIS LINE � <br /> PERMI7CONDI710NS (`l <br /> 7.Ail calls for inspection shali be made 24 hrs.in advance-phone 259•88�0. V <br /> 2.All work shall be performed in acco�dance with this permit and current City of Everett Design and Construction <br /> Standards and Specifications. �\ <br /> 3.Call Location Untlerground Service 48 hrs.before you dig.TOLL FREE NUMBER 1-$00-424•5555. `, <br /> y CXiSfi�,J S�a�SC�✓�r Gcn�r f�' /� Z <br /> 4�"uc�nC✓ �� � oi'_tc^ imGff6� i^3i-vc�l'�•U� <br /> / c hovsc or -��i� r+,:•� r / /� o <br /> ��/� T�'� L/h//O:N. / (' ��2C��qbvL'.lJ' GC C�rq rZG�' <br /> �t[��Oih4 �CJ�G�r C=.!'� u <br /> ��.:•,-ri„ ui�o�.- 6 � « ��� �SZ'..✓c.- iS fa <br /> �•.Ld.�s 4 CC-R.,• � <br /> ovY i�, <br /> U� c:a [�i ".c�/ nf �/,� G.�.'l ' v'} G�: /nS�o C!<<� <br /> d..> � <br /> � ' <br /> O <br /> � <br /> C'K� ACKNOWLED�3EMENT OF CONDITIONS <br /> _ The unden;igned owner/applicant hereby agrees to t:old and save harm- <br /> less the Ctly ol Everelt Irom any antl all claims for tlamages, wsis, <br /> /'�� �� expenses, or causes oi action !hat may arise 6ecause cl installatien <br /> A �� Z � ., and maintenance ol the improvement or nther right�obway use hereto <br /> pproved f onstr ction Date applied lor and luriher agrees to �emove same upon netice Irom the <br /> / / f / City and to replaca pubLc property�amaged ihereby. <br /> � <br /> F;NAL IN PECTIO % � � ��� �� <br /> <�uF�oved as Constructed `�� � a�e (�a �� - '�V _�� <br /> Sign�u�,e ol Apphcan( y <br /> PUBLIC WORKS DEPARTMENT W�RK qUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> 3200CedarStreet 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everett,Wqggpp� BE DILIGENiLY PURSUED TO COMPLETION. THIS PERMIi MAV BE <br /> Phone:259-8810 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WpRK ON THIS <br /> PROJEC7 O�;ER 90 DAYS DURATION. <br />