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��. <br /> -- - -- - ; . _:_'_ -. _� . .. _. . _ . . ,i <br /> � . � � " a i � T I��LL'J� v�ei�cwo,x�v.,mn. �, , Z /�/ — <br /> Dale �-'R-92 B�ao o�o� • 37546 — <br /> qpplication Fm — <br /> PUBLIC WORKS PERMIT °°°"`"'°'""`° S <br /> r�.,w�F�e <br /> �essnooi�ee ram 5 — <br /> p�� TO PQSTING 3��' Baiance0oc S�� <br /> � , Print or Type Only <br /> � Ht~i� � ._ <br /> N �� Oniverse Conetruction 2529 189th SE Bothell 96012 481-Z�66 Gordon Lippmann <br /> Owner Mallino Address <br /> Ciry Phone <br /> K f] <br /> H 70 <br /> 'OO M� �WitOi -- Z�P phone <br /> � y� APp���a�� Maihng Address C��y <br /> xOOO <br /> O M � Descnbe ProPosed Work $eW hOuee cons[zuc[io+t __ <br /> � � g - --- <br /> Q• O <br /> xy � � � <br /> �� y ��jz� �C—"iziDi,�,�,...���� 3' �70�— s ; — ,��� � <br /> y Proiect Address(i'know�) <br /> ��y - <br /> � Ai�ach four(41 coo�es e�plan5lor proposed work-Oraw io scale aotl nW.e ihe lollowing as app� "`.'"� � <br /> • Pruperry LineS • Cemledine of sireet� <br /> y H y • Outlme and dimer,;ons ol all e*isting and • Indicale Norlh <br /> � proposed stmcturea on the lot • Show any proposed grad�ng chanqes � <br /> � . G Eaistin9 and ProP�sed Wilities <br /> • S�iow measu�ements <br /> DO NOj�NRi iF_ F3ELOW THIS LINE O <br /> 1 .. PERMITCONDITIONS � <br /> i.All calls br inspection sha�i be made 24 hrs.in advance•pho�e 259•8810. <br /> C� 2 All work shall be periormed in accordance wilh ihis permit and current Cily ol Everetl Design and Consimaion <br /> Standards and Specilicetions. � <br /> 3.Call Location Underg�ound Service 48 hrs.betore you dig.TOLL FREE NUMBER 1•800'424•55 . I <br /> � �� Cvrn � l,� w �.� l , �, II c` V� ici . l_'� V.� � JL _�'�u�� -{ � ���"� � <br /> I � <br /> �- �Z�z- � �-U�� . <br /> � <br /> � <br /> � � <br /> I � <br /> ,.. 5� g om � � <br /> J � � "£+ }K £ � �q�+l(�Yf.E04EMENT OF CONDITIO^1S <br /> t f� S <br /> � .;.,�19 � ' �1fie o�d"erstpned ownei�aRPl�Oant he�e�y agrees to hold and save harm� <br /> . � less.��e Cdy ol [ver�ef froirl'any and all Gaims lor damages, costs. <br /> `,a �ezpC4isea or causee bf action that may a�ise because of insiallation <br /> �� � �^ i� I� Q_"JQ_ �'L �� �aLfU mail��epellGelohYhe imp`ryvement or other righbobwey use hereto <br /> ` �J G I 'n �a�11e�-����a�grSHer agre�5 lo remove snme upon notice Irom the <br /> ppproved lor Construclion Date � �r-�p��an¢� e�a� `�bb�P��e��Y�amaged the�eby. <br /> ,p <br /> % �� �� > <br /> � � � �i � _�, 5� _ - <br /> '' = y—' �z� � iL-� _ <br /> FINAL INSPECTION Date Date <br /> Signoiure ol�Applicanl� �_j <br /> ApP�oved as Construded WORK AUTNORIZED BY TN�S PERMIT MUST BE STARTED WITHIN <br /> � PUBLICWGRHSDEPAfi�MENT 180 DAYS OP DAT[ PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200CedarStreel BE DIIIGENTL� PURSUED TO COMPLETION.THIS PERMIT MAY BE <br /> Everetl.WA 98201 CANCELLED BV THE CI i Y UPON ANY STOPPAGE OF WORK ON THIS <br /> Phonr 25P�B810 PRCJECT OVEF 90 DAVS DURATIGN. <br />