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INSPECTION REP�RT <br />� T�Y.�PE� O(F� �INSPECTION REQUESTED �� <br />❑ BLDG: Pmt. No.SrL.�d�—L� ❑ MECH: Pmt No. <br />❑ EIEC: Pmt. No. � �� ❑ PLBG: Pmt. No.____ <br />� Housinp 0 Masonry � Insulotion <br />❑ Footinp ❑ Froming ❑ Gmundwark <br />� Fomdallon ❑ Drywall Nailing ❑ Censultotion <br />� $ewer ❑ Rouph-In ❑ Final <br />❑ FlreDloce and Chimney ❑ $ervice ❑ Oiher <br />� APPROVAI. ❑ PARTIAL APPROVAL <br />❑ VIOLATION ❑ CORRECTION REQUIRED <br />❑ Corrections listed below MUST BE MADE belore work con ba opproved. <br />❑ Work listed below hus been inspected ond opprovcd. <br />❑ Pleau conmct inspecror and arronqe (or opvointment. <br />❑ Was not oblc to perfoim insptttion. <br />❑ CALL 259•6870 fOR REINSPECTION — 24 hour nolice required. <br />A Certi(imtc of Ottuponry sholl be issued and posicd on Ihe premisen prior b xeupeesr. <br />0 <br />� <br />� <br />everen qppLICATION FOR P+�SLIC WORiKS PERMIT <br />� TYPe or Print cleadY wilh ink ��� <br />PRES: HARD • YOU ARE MAKING CUPIES pERMIT NO. <br />PUBLIC N'ORKS <br />EVERETT, WASHINGTON E3LDG. DEPT. NO.—_ — <br />3 -2 y- o�z <br />❑OWN[R RQAGENT D.4TE _._---------- <br />y n I <br />�C�N7rGI LJ��CfQr� LhJ/G.� ___—._.--.__ <br />APPLICANT/FIRM REPRESENTED — - u <br />ADORESS 2 7U2 ��'-�-T-S I�°=— / ciTv C��p�[ �T TELEPHONE �S 2�� �� - <br />��oe�l OF_ .�,IeIoW4l�: �fi0•=r.�le �u �I�oc�:ei-rl�r-. <br />HEREBY APPLIES FGR PERMISSION TO 1 � <br />/1 r I <br />\Re1'MJJ�N U� ��U1....� M.+f�l�1 _. <br />�,.�__='`'.,t+ _fl_,�,_�,�__mAa�� 2� � <br />ATTHEFOLLOW�NGLOCATION 2�02 �I o�������'— _--- - — -- <br />Attach five (5) copi�s of preliminary plans (or proposed work. Draw to scale and sliow the following as applicable: <br />• Property lines and street identity. <br />• Outline and dimensions of existing a�d <br />proposed structures. <br />' Existing and proposed utiiities. <br />' Centerline of abuttinc� right of way. <br />PUBLIC <br />CONDITIONS: <br />. . �JC..l1 1'� '! <br />� S J.,...Ja -- <br />. . .. . ���,..,.,- i <br />� �-- - <br />'i , . . . . � �.�..,� 4 I <br />� i <br />�-r=. �. �-' �.''. � j � � <br />K -0% <br />�/ <br />/ /: LL <br />A,PR E� FOR CON UCTION � DATE <br />APPR� S CONST. CTED �-i� <br />� <br />PERMIT IS Vl+LID FOR "1 YEAR <br />EXPIRATION — <br />a <br />r <br />� <br />- <br />• Topographic changes requ:ring cuts and fills <br />other than normal toundation. <br />' On-site drainage systems whe� required. <br />� Erosion controi melhods when required. <br />� North arrow <br />.� ��) <br />__l:% (�_.�._—Si9��rcot�PP�eni — ____—_ <br />RKS F�ERMIT <br />Sf'%. J /1/<� ._7�— c.�i�c, % =� <br />/I; ,:�;/ <br />/ ��T <br />� <br />The undm;,iyned o�.vner here�y a9�ei'% iu hoh. und sa'+e harm ess <br />Ihe Cily ol Everetl troin any ano au ciaims br damages, ccsls, <br />expensee, or causes ol aclion �hat may arise because ot install:lion <br />and maintenunce o: Ihe improvement or ather nghhol�way use <br />hereto aOPlied �or and Iwlher a9�ees �o remove same upoa n�•Ilco <br />Imm lhe Ciry and to replace p�iblic properlY tlamaged �hrreby. <br />ACKNOWLEDGEMENT OF CONCII'IONS <br />31GNATURE OF APPLICANi DATE <br />CF.LL FOR INSPECTION <br />POST OIV 259-8811 <br />JOBSITE 24 Hf�S. BEFORE CONSTRUCTION <br />