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Date 2-ll-95 yp G �-2q-� �/ / <br /> TO 1 O./1 I��— Puenc works Pc.mn< I � �JCW ✓� <br /> Application For '�—�� eieq.DeP�.e _ 47(144 <br /> PUBLIC 11VORi(S PERMIT PUb7malFeeFao S <br /> Less AODI.Fce Paia S <br /> Print or Type Only ' ci r�; � �_� �_� a�i;pce�Due�� S '�i��j �B <br /> �_ <br /> ��:� �,�i �_� c.� r� <br /> ii'i i�'i . � ci r,i - .ii rb� t- .. <br /> tr� ., irt r_ . � .� i'y r.i <br /> � '- , .�� in = 1-. :,-, <br /> Cornerstone Prosthetics 4202 Hoyt Ave CVerett� 982b'1 339r2559 <br /> Oc;ner MailingAddress r, [ City�� n, o Zi i <br /> �� r � � � r• � i i p,. r i� u� ._ Fhone <br /> f. C] ' � � t7 Itl [j t 1 fJ i i r �� r:� <br /> Botesch, N8S}1 & Hall ' r' �� c� F Ga ui r.� .: I�i <br /> Debbie McCauley ;,25g�{pa[�g !; �,� ,�, � i_ _� r � <br /> � � ,, � <br /> Applicant Mailing Address �� Cit <br /> Y Z�P Phone <br /> Describe Proposed Work new office buildinp�_ <br /> P�oject Address(if known� 1300 44th St SE � <br /> Attach lour(4) copies ol plans for proposed work- Draw to scale and nole the following as applicable: � <br /> • Properly Lines � <br /> • Centerline of stre2t � <br /> • Oulline and dimensions ol all existing and • Intlicate North <br /> proposetl structures on the lol • Show any proposed grading changes <br /> • Existiny and proposed utilities • Show measurements <br /> DO NOT WRITE BELOW THIS LINE � <br /> PERMIT CONDITIONS O <br /> 1.All calls(or inspection shall be made 24 hrs.in advance-phone 259•8810. <br /> 2.All work shall be pedormed in accordance with this permit and current Cily of Everett Design and Construction � <br /> Standards and Specifications. <br /> 3.Call Location Underground Service 48 hrs.belore you dig.TOLL FREE NUMBER 1•800•424•5555. <br /> �-, ,45 �- �P�ra�ed�o%�s d��� 3��y� � <br /> � <br /> �� .S�hcdvl� pr�e�,s�rv�t��a-� �2c�� k.;� p�r l,��ks ��sPec�.,- � <br /> P�'�' � bc5n-,�,'�,� ��s�-v��1e� �I�'inn�s (.'�z►Lem�� 3��103 � <br /> �o, I� S�E�,✓lerl�5i`c+� c��l/ dev�ces �s d,re�ted � ���l,z wr,r,�r � <br /> � <br /> I/lS��/' — a-� r n-+ .L�., ;�nvrn � s��-� -�/!c� �ZY S� ��Sfd � <br /> 5 hti�'1 Sc ,1�5-1z�!lcd a-E ��1, a,�d ui�sf 5��f�r-ta 7�i� ��/an�. <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> - The undersigned owner/applicant hereby agrees to hold nnd save harm- <br /> _ � � less ihe City of Everett from any and all claims for damages. costs. <br /> �� � � expenses. or causes of ac�ion that may arise because of installation <br /> !� � nd maintenance ot ihe improvr,ment or othet right-of-way use hereto <br /> A p ved tor o ruction . apClied for and further aqre to remove same upon notice from the <br /> Date Cit and to re lac <br /> . �. ' ) , Y�pu c p erty damaged theieby. <br /> � '`�l' �/ - '�'j . <br /> NALINSPECTION p2�e ' �-I�� 6S <br /> Approved as Construded Signatur �b/ p icant <br /> Date <br /> PUBLICWORKSDEPARTMENT WOR U IZED bY THIS PERMIT MUS7 BE STARTED WITHIN <br /> '�� 3200CedarSireet 180 AYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everett,WA 98201 BE DILIGENTLY PUFSUED TO COMPLETION. THIS PE=RMIT MAY BE <br /> Phone:259�8810 CANCELLED 81'THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAYS DURATION. <br /> _ . _ . .. �•�r.--'.c.��.. <br /> P' ' : J , � s : .,r � +� <br /> .. . <br /> v� +' <br /> ,� � -. - , . -: <br /> � ,. , <br /> ,� .-- �... _;�.,�� , .. �� � <br /> .a � � > . <br /> % � rL�[r . v- � . <br />