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� � � <br /> A� x <br /> Cy :� <br /> t" f� V1 <br /> H �� <br /> FC C� <br /> H �7 <br /> "�V M '0 <br /> V�H � T-1�.-z..8-`f' ,�� �T <br /> xO�" Date 10 22 91 r„c���w�,�,r�,m,�917 <br /> t�7 �+�4 A eioo oeoi •. <br /> y pplicalion For <br /> PUBLIC WORKS P'ERMIT PueTo�FeeFee s <br /> ��g Las�ApD�iee P�ia s,,�— <br /> " " 3�alg� <br /> H � <br /> z ~� TO POSTING_.. _ Belence�ue S �� <br /> .�., y Print or Type Only <br /> � <br /> Ny <br /> y <br /> M <br /> ��� I,ippman Dean 6 Erica 6404 Highland Dr11B Everett 98203 347-8906 _ <br /> r �y.�,�e� MailingAddress City Zip Phone <br /> yL��7 <br /> HOvi <br /> qpplica�i� Mailing Address Ci�y Zip Phone <br /> Construct new SPR <br /> Descrihe ProPosed Work _ <br /> W <br /> Prolec�Addresslifknown) ]y7A M idi AyQ — � <br /> Attach tour 14)copies of plans br Droposed work� Draw to scale and note I��e tollowing as applicabte: � <br /> • Property Lines • Cent�rline uf street '^ <br /> • OuUine and dimensions of all existing and • Indicate Nonn V� � <br /> proposetl stmctures�n the lot • Show any prcoosed grading changes <br /> '�' • Exis�ing and p�oposed utililies • Show measurements M <br /> W <br /> 1 ' DO NOT WHITF. BELOW iH15 LINE O <br /> � <br /> PERMIT CONDITIONS <br /> '�1 1.All calls for inspection shall be made 24 hrs.in advanca-phone 259•8810. � <br /> ' ' 2.All work shall be peAormed in accordance wilh this permit and current Ciry ol Everett Design and Construdion <br /> Standards and Specilications. <br /> � 3.Call Location Underground Service 48 hrs.betor.,you dig.TOLL FREE NUMBER 1•800•424-5555. � <br /> 1 —�i�=T—__�_�_- _'_ __ _ `_—"_�_-�I_-v;� 1 ' ' _ � � <br /> ' <br /> ; a �', C.or�ect fooF �,�c{ -�ooL--'�ny c4v��S {-g� s1nrM dra,l� /A <br /> V♦ <br /> � stv b l.ilca�ec. a t ,$t G.>r ne.r o�' 10 � . O <br /> '_� a <br /> '�I _�� ///�11 ACKNOWLEDGEMENT OF CONDITIONS <br /> - C,�(ly� The uncersigned owner/app4c:n1 hereby agrees to hold and save nanm <br /> �v less Ih�� City ol Everett Irom any and all claims �or damnycs. aosts <br /> expens�s, or causes ol ar,tion Ihat may arise because ol installation <br /> P� � n/�L, oO fO _Z� _Q, and maintenanCe ol Ihe improvement or olher nghFol way u5e hereto <br /> 1 r 1 � applied lor and luriher agrees to remove same unon nobrc Irorn the <br /> Approved for Consiru n �a�e Ciry and to�eplace public properiy damaged ihere6y. <br /> .��-��. 3//-�'L /[� � , <br /> Dale lj��-fi'l O . - �2Z.O�JL�LJ <br /> FINAL INSPECiION Datc <br /> Approved as Conslructed Signalure ol ApPiicant <br /> � N'OHK AUTHORIZ6D BY THIS PERMIT MUST BE STARTED WITHIN <br /> � fl;�L�CWORKSDEPAR7MENT 7B0 DAVS OF DA7E PERMIT IS ISSUED AND TH[REAFTER IS TO <br /> 7np,..edarSlree! �E DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT A1AY BE <br /> Evc�e��.WA98201 CANC[LLED BV THE^ITY UPON ANV STOPPAGE OF WORK ON 1i115 <br /> Phune:259�8810 PROJECT OVER 90 DAYS DURATION. <br />