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�� <br /> � <br /> Date�9/95 "�cT�NG AUO 0 2 20� qS"/.�q I/ <br /> .r Pubbc Worta Prrmn� __.f <br /> Application For c, eiey oeo��• G0� •� <br /> r.. <br /> PUBLIC WORKS �ERMIT Pu�hcWor�aFee <br /> � To1N Fee : <br /> O <br /> OLeas�p01 iBe PaiO s��r�� <br /> Print or Type Only �' � v �+ � � c� rn � r. B�i^�c��o�� f �7� <br /> :ii �o + G7 [�� n �o tT n �• <br /> r^• .�, � (1 � M If] M d � <br /> r-1 f: �� ro r n� b <br /> Edmonde Bldg Co 847 Dayton E mou�sa 98�i2a� � �7�-7�6� �� <br /> Ownei Ma�liny Ardr 55 ' r c' yi b i;i o�I�o E�i �q� o � � � Phone <br /> `� �� nL1 O !- UF O .:tU7CI �. '. W <br /> Statl St[1Ck1eRd 793-2326 � � "' �++ � � � � � !n �n � �; n i i <br /> Applicant M:,�6nq Address Cdy Lp Phone � <br /> Describe Proposed Work __ NeW 9 unit a�artment_ ____ _ ___ <br /> Proiect Address(il knowN ��_L_LL_.—_�%Lr����t---- — --- � <br /> A�taCh four�4) cop�P.S ol plans to� piopused work � D�av: to.caL� anA nole Iha f0ilowmg as 7pplicaAle. � <br /> • P�operty Lines • C�anterhnr, N sireet � <br /> • Outlme and Aimensions of all exishng anA • Intlica�� Norih <br /> propose0 struc�ures on the loi • Show any nroposeA grading changes <br /> • Ezisting and proposed utilities • Show measurements � <br /> DO NOT WRITE BELOW THIS LINE <br /> PERMIT CONDITIONS O <br /> 1.All calls tor inspection shall be made 24 hrs.in advance•phane 259-8810. � <br /> 2.All work shall be peAormed in accordence with this permit and current City of Everett Design and Construction <br /> Standards and Specifications. <br /> 3.Call Location Underground Service 48 hrs.betore you dig.TOLL FREE NUMBER 1-800-424•$555. � <br /> � �..�,. ��,�G,,.��� � �� �� g - � - 9 s- O <br /> F- <br /> � <br /> O <br /> a <br /> ACKNOWLEDGLMENT OF CONUITIONS <br /> 7hr unAe��iqnetl owner/appl�cant hereby agrees lo hold and save harm- <br /> ---�� less Iha GIy of Everelt irom any and all claims tor damages. cosis. <br /> � expenses. or causes of action that may aris? because ot inslallation <br /> �� � anA mamtenanre ot ihe improvement or other nght-pFway use hereto <br /> I appt�eA�or antl f rther agrees to remove same upon notice trom the <br /> App�ov. d for Co t �on Date � Gtv and,to ic:p1 pub properry damaged thereby. <br /> � i r <br /> FINAL INSPECTION Datc I �� <br /> Approved as Constructed Signature ol Appficant Date <br /> PUBLIC WORKSDEPARTMENT H'ORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> 3200CedarStreet 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER I$ TO <br /> E• -ett,WA98201 BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAV BE <br /> F��ane:259�8810 CANCELL£D BV THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> , PRO.IECT OVER 90 DAVS UUP.AT!ON. <br />