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S/20/91 � � � - <br /> Date - . . ,,,�,�..:��;�.,��m . <br /> a��u o..c: ._91/27560 _._— — <br /> Applica�ion FOr <br /> F`UBLIC WL`RKS PERMIT '°°°°,"°�`°`°° -- <br /> ,o�a��e� s <br /> «>..�,o�F�e PT,� s <br /> a��a������ s <br /> � r�p Print or Type Only <br /> [�7 <br /> >H <br /> A �1 x <br /> 9 y t~i� IIob [deis 1713 SJ Silverlake Rd Gverett 337 7730 <br /> Hxa � ���.�i� MailingAddress Gty Zlp Phone <br /> HZM <br /> o y O Rockey & ldork Contractors 2021 Lombard Evetet[ 98201 252-1311 <br /> hd N � Applicant Mailin9 Addmss City Zip Phone <br /> NM <br /> [�7 O� Descnbc Proposed Work 540 sf addition_ <br /> �-3 C <br /> OM <br /> �� g <br /> 4]V (� _ <br /> zH� W <br /> � y �I-1 y Projec�Address(�1 known) 1 71 7 jd tiYSN7iRYT Si 1 vrrl�kL <br /> y <br /> H Atlar.h lour(4)cop�es of plans lor proposed work-Draw Io scale and note Ihe lollowino as applicable: � <br /> n r1 N • Centedine of sireet /A <br /> • Proper'y Lines <br /> � t" • Outline and dimensions o�all ezisling and • Intlicate Norih V� <br /> y y proposetl slruclures on the lut • Show any proposed 9rading changes <br /> y O !/� • Eaistin9 and propnsed ulilitics • Shnw me:uuremr.nts /�/� <br /> � DO NOT WRITE �ELOW THIS LW[ O <br /> PERMIT CONDITIONS <br /> 1 1.All calls lor inspection shall be made 24 hrs.in advance�phone 259•Bu10. � <br /> i2.All work shall be pertormed in accordance with Ihis permit and current City o'Everett Design and Construction <br /> �� Standards and Specilicdtions. <br /> 3.Call Location Underground Service 40 hrs.betore you dig.TOLL FREE NUMBER 1•800•424•5555. � <br /> ► <br /> � ��9 ' ,;� ��nl` �4 «,�.� � <br /> � t�� L �CG{� CL�O71-'o �G'�� �� � <br /> �� <br /> �l��� �5' �2-<)/ � <br /> � <br /> �_�_ a <br /> � ACKNOIVLEDG�MLiJT OP CONDI110NS <br /> �� � _ IheuntlersiyncAownor/appLcan�heiebyayreesiol�oldandsavehann� <br /> --- — ---� -- - I i�,;s the Cdy el Everett Imm any and all claims tor damages. costs. <br /> . _ � espenses. or causes of actlon thal may arise because of Installation <br /> and mamtenance ol Ihe impwvement or oiher rigM-o4way use hereto <br /> ;apph��rf lor and iw�hw dqiees �o remOve same upen no�ice �rom Ih�� <br /> Approved lor Consiruetion Dale �,�y .,�,� in i��olace� pubhc nronrrp�dan�afled Ihe�eby. <br /> FINAL INSP[CTION �atc —_.. ---- — <br /> APPwvetl as ConSirucled Suu���lure ol Applicanl Date <br /> WORK AUIHORV_ED 8Y THIS P[I71dIT MUST BE START6D 141THIN <br /> t PUBLICWORKSDEPARTMENT 180 DAVS OF DA7F PEf,MIT IS ISSUED AND THEREAFTLR IS TO <br /> /�—i, 3200Cedar5�reet BE DILIGENTLY PURSUED TO COMPLETION. THIS PERM1IIT A1AY' BE <br /> �'�� Everetl.WA96207 CPNCL=LLED I3V THE CITY UPON ANY STOPPAGE Of WORK ON THIS <br /> Phone'.253��3I7!0 PROJLC7 Ov[R 30 �AYS DUiL1TIO�J. <br />