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oti . . .... . . . . . . . .. . .. . _ . � , . <br /> / <br /> �'�"?�:� c—'�2lZCr�_ <br /> Vub��cWoixsPcrm�i� _Z.--�— <br /> Date1/13/�2 �O hn����C / - / . ___ <br /> ��� � _� �i.ri o�o� . 37343 <br /> ApPlication For � --_. <br /> �'JC7H Puo�iolalF�cGae � � <br /> ��'� PUBLIC WGFiKS PERMIT <br /> 9�J tess aoo� Fee Pa�a 5 <br /> 1D'.L1H I paia�ceouc 5 ��� <br /> a"�y• � Print or Type Only <br /> H ZH <br /> � H� <br /> � H� Jame^ L Leopold 8207 - 181 st P1 SW Edmonds, PIA 98026 672-0383 <br /> f/�H <br /> Owner MaJinyAddress GIy Zip Phone <br /> � O� Owner <br /> N d Applicant Mailinc�Address Gty Zip Phone <br /> O �-+ <br /> H CT]O <br /> G�V � <br /> 1.-I Describe�roi m ed Work ConGt�LS� t ew SFR <br /> r �+� �7/ OZ <br /> m 1 � 1 <br /> � ��j'a`�`� W <br /> n dN <br /> Jefferson nve � <br /> [�xj ���iy P�ojec�Address(il knowN � <br /> z H Cn �� <br /> H O CA Attach four�4)copies of plans lor proposed vrork- Draw Ic sr�le anA note ihe foll�win9 as applicable: <br /> • Pioperty Lines • Gen�edine of sireet r^ <br /> t Outline and dimensions ol all existing and • Intlica�e Nonh V� <br /> proposed sirucW res on ihe lot • Show any proposed gratlin9 chan9es <br /> • Existing antl proposed utilities • Show measurements /�/\ <br /> W <br /> �O NOT WRITE 6ELOW TNIS LINF /� <br /> '�" � PEFiMITCONDITIONS <br /> � <br /> ,.-. � 1.All calls for inspection shall be made 24 hrs.in advance-phone 259•RE1Q. � <br /> 2.All work shall be pedormed in accordance with Ihis permil and curren�City of Everett Design and Construction <br /> Slandards and Specifications. <br /> f� ,�,' 3.Call Locntion Undergmund Service 48 hrs.belore you dig.TOLL FREE NUMBER 1•800•424•5555. � <br /> m <br /> �, C���,��f dow�s�o�-FS >4� a .-r��,� �;' !/ed ,ti,-�}1-��-f;w� � <br /> .,a � '�re-,-� ol�. L <br /> ,� � � � ..��d �F".� e�jz �G, �rt �� � <br /> , ,-;�?w /Y,v,-F �.e �t au.E' <br /> i ' �C�c'✓ �d �OrU,t'P�/�j �G�. O <br /> / % u � <br /> � .' 1 `i. ,��2e�o .S'7/`ec 7'S G�e�i v� mL 7 �.(/ �L.`a'� • a <br /> `0� � ACRNOWLEDGEMENT OF CONDITIONS <br /> �Y� r <br /> ��. ,y ,�� _ _ ;he urderigned o�vner/applioanl hereby agret 5�o holtl anJ sace nann- <br /> � loss the Cn}' o� Everel� irom any and all clalms lor c7nma��es. resis <br /> _L� enPenses. or ��iuses of aclion ihat maY arise because ol ms..illatien <br /> C�ip C7�� G19 and mainlenance c! !��a ���^rovement or other right-obway ��s�.� t���reto <br /> F�e � - �L applieq for and lurther agrees �o remove same upon nouce iroin !ix• <br /> AnProve J IOG�Construction, � Dale Cny and Io replace pubhc pr ty Jama9ed thereby. <br /> , 3 � �, I <br /> / - " Q�. �';`�' <br /> �It AL NSPECTION� Dale '_ __ <br /> AnPrmetl as CunS�mCled Sigiu we ol?oplica t D,ile <br /> WORK AUTHORIZED BV THIS PERMIT MUST BE STARTED WITHIN <br /> � � PUBLICWORKSDEPARTM[NT 180 DAYS OF DATE PERMIT IS ISSUED AND THERE�FTER IS TO <br /> ,��� 3200 Cedar Street 8E DILIGENTLV PURSUED TO COh1PLETION.THIS PERMIT MAY BL <br /> Everetl.WA9A201 CANCELLED BY TFIE :ITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PRonp�;Ci9-BfI10 pqC1JLCi OVF{7 00 D9Y$ pURATIOId <br /> �___ __ _ <br />