2216 COLUMBIA AVE 2016-01-01 MF Import

� ; � � � , >� y � $� p / ry� p. Date 8/25/92 T� B(�rril�r �,./—v+ 2o'S PuoimWo�hePermn� 9� '� , H � H . — °Z�'3 oie9.oeo�.. 37800 � Applicaflon For � � y� PUBLIC 'WORKS PERh�IT PubTalalFeeFp� S I y x , . , , LefaApOlFeePmO S � �� Print or Type Only � , ea�a��a o�< s �� � �b � � �Y (� NSC PO BOX 3376 �� Everatt, WA 98203 � 346-8308 � � �y� Owner Malling Address City'� , , Zip Phone � HH g�� Owner �� n b y Applicant Mailing Address Clty 2ip Phone �� �y y Describe Proposed Work t'onctrnrt n�w SFR _ HO [n — �Z� �o _ W Proleci Address iif known) �� Columbia Ay�__�T block 22 of Pinehurst Div H) � Attacl ��ur(4)copies ot plans lor proposed wo�k- Draw to scale antl note Ihe lol!owing as applicable: � • Property Lines • Centerline of 5�rect ♦^ � • Oulline and dimensions of all existin9 and • Indicate Norlh V� Froposed structures on the lot • Show any proposed gradin9 changes -�! • Exi5ling and proposed uiilities • Show me25uremenis � DO NOT WRITE BELOW THIS LWE O . PERhSITCONDITIONS '�1 1.All calls for inspection shall he made 24 hrs.ir adv�nce-phone 259•C81 O. � �� 2.All work shall be pedormed in a�cordance H�;ih this permit and current City ol Everett Design and Construction ' ' Standards an�Specilicntions. . � 3.Call Location Jnderground S�rvice 48 hrs.before you dig.TOLL FREE NUMBER 1-800-424•5555. � �—� � . l�r�� i v��v,ny .sHA[� �3�Pqy�i� \V i7}I ASPNAL-t" �i��9 O I �� G-vf�f= o]�T-�1vE �J7- / � t� �"f N �_. o.�v. 7z� i��vl�.� LIN�, r � � � COhl572c,��T �,e�A.h_N �,� �,�1 j 02 /z'Ci?/-TG'0 k'clr✓�� �� �_� � , �1 ,VLl�/ PVG i��72 �/J�K�I,�lv�S��-cC c�E � � � 1NS�L�EU �T�v�� t�a.�SE z' �IX�C o�" /z,c�,�� Q. �' � ' ACKNOWLEDGEMENT OF CONDITIONS . .� � The undersigned owneri:�pplicanl hereby a9rees lo hold and save oeim� , — less ihe City ol EvereU trom any and all claims lor damages, costs. ,7- � ,�� /� ezpenses, or causes o� 2ction Ihat may arise Uecause ot inctallation � � � y�//r C 9 and muintenance ol ihe '�mprovement or other righl-ol-way use hereto T '- � �—[�LC�+ �� v _��z applied lor and luriher agrees to remove same upon notice Irom the � , �b,i,�..-.'.j -,. . Approved I�or�str�n Date City and to replace public property damaged thereby. -•��.,� �:;5q"�� � � i:�: /�/�� / � � FIN L SPECTION .� D3 "'�L''�M^ LI , S�L� Approved as Constructed Signature ol A��plicant Date ��E��_ PUBLICWORKSDEPARTAIENT �VORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITNIN 3200CetlarSlreet �RO DAYS OF DATE PERh11T IS ISSUED AND THEREAFTER IS TO Everett,WA98201 BE DILIGENTLY PURSUED TO COMPLETION.THIS F'ERMIT MAY BE Phone:259-8810 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WJRK ON THIS PROJECT OVER 90 DAVS DURATION. �;