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� � <br /> 2/24/95 � PUEImWorksPormil• � • � <br /> 'Date �!� POSTING �P� � � �99 eiaeoeo�.� 47080 <br /> Applicalion For�_� <br /> PUBLIC WORKS� PERMIT PublicWo�ksFee <br /> Total Fee S <br /> nLess AC���Fee Paid $ ���sss <br /> L' � � � �>� C�'� Oa] P � � Balar�yp Du¢ 5 .� �� <br /> Print or Type Only � , �„ '" °: : ; � ;: <br /> , .ti � .s o o � o rriordoo� <br /> �, JJ If] C- O] IfJ <br /> c� o- n� w r, .� tn ri r� a� a� <br /> .� n� �,, �� ��. w a «i .ri� o �: <br /> Americ-n Profiles Co 11403 120th Ave ��� Ki,r,�clan� ��33 m '�821-2',15� <br /> Owner MaJing Ad�reas t� c� x a� cC�ity � w u� u7 ip Phone <br /> �+ e,t c� a (� r�� rc �� o � p. zN �w (� rr •, <br /> ti G1 L'l 2 Q W G LLi �. O I+J l? � 1�� LJ GJ <br /> � N p p [..1 :: O 1— O 3 U O 1 Q \ \ 7_ 2 LLI <br /> � OJ ic _J [.] ¢ O W 'v' OQ. 0331-� 1-� I: <br /> Woodtape � xwuac� x :3amu� �cs an. n onci <br /> +� Phone <br /> Applican� Mailing Address City Zip <br /> New concrete tilt—up w / metal roof <br /> Describe Propo/�5e_d Work , <br /> �! !"�• (A FfIY' _T�/A��•✓ t�/12- /Xtit/'//'Y <br /> W <br /> Project Address�if known� 2300 Aierrill Creek Pkwy � <br /> Attach four(4)copies ot plans for proposed work• Draw to scale and note the lollowing as applicable: � <br /> • Property Lines • Centerline of streat � <br /> • Outline and dimensions of all existing and • Indicale Norih <br /> proposed structures on tne lut • Sh�w any proposed grading changes <br /> • Existing and proposed utilities � Show measurements M <br /> W <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 1.All calls for inspection shall be made 24 hrg.in advanco-phone 259•881 O. � <br /> 2.All work shall be pedormed in accordance with this permit and currenl City of Everelt Design and Conslruction <br /> Standards and Specificationa <br /> 3.Call Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1-800•424•5555. � <br /> .�, ��,. ��,�.�,,.����•�- ��� �/-z/-9s" O <br /> ~ <br /> � <br /> � <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees to holc'and save harm� <br /> � less the Cily ol Everett Irom any and all claims for damages, costs. <br /> expenses. or causes of ac�ion thal may arise because of inslallation <br /> � _ — d maintenance of tlie improvement or other right�of•way use hereto <br /> applied for and further agrees to remove same upon notice irom the <br /> Appr e or C ru � - Dale Ciry and to replace uhlic Perry damaged thereby. <br /> i-- � <br /> �� ' � � � � ��� � <br /> T� � � <br /> INAL INSPEC O Date Date <br /> Approved as Constructed ignature ot Applicant <br /> W09K AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> PUBLICWORKSD'cPARTMENT 1B0 DAYS OF DATE PERMIT IS IS.�iUED AND THEREAFTER IS TO <br /> ������ 3200CedarStreet BE DIIIGENTIY PURSUED TO COMPLETION. THlti PERMI7 MAY BE <br /> Everetl,WA 98201 CANCELLED BY TFIE CITY UPON ANY STOPPAGE OF WORK ON 7HIS <br /> Phone:259-8810 pROJECT OVER 90 DAYS DURATION. <br />