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�' ,. <br /> � � <br /> I�I A� y5 .. . � <br /> C H <br /> 1��� <br /> K <br /> � �� <br /> �y� _s � <br /> � N-zl -L`i q� �� : <br /> p Date_�—�f1n92 P�cu�wo�hsre,m�i. <br /> y eie9 oeut• 36803 <br /> O N Aoplication For <br /> C <br /> ��'g PUBLIC WARKS PERI�jI�'n5��hr a PUeTotalFeeFea s <br /> �ess ApO��Fcc PaiJ $ q <br /> "�> H eaiance o�e S Jc.�'�J <br /> M , <br /> r H H Print or Type On�y <br /> � <br /> H <br /> g�y ; : <br /> � � ROBINET"L' 6 BRANUVOLD 1�831 COLBY AVE EVERETT 98201 252-2500 <br /> y Owner t:AaiFng Address � � Cjt� Zip Phone <br /> O fn <br /> � D C RRANDVO 568-9342 <br /> Applicant MaJing Address City Zip Phone <br /> �� Describe Froposed Work new construction SFR <br /> _ W <br /> F�oject Address(if known) � 1 3Z — z_y�=� � H <br /> Attach four(4)copies of plans lor proposed work- Draw to scale and note the lollowing as appticable: � <br /> • property Lines • Centerline ot streel ,A �. <br /> • Ou��ine and dimensions of a�l existing and • Indicate Norlh V� <br /> fF�' proposed structures on the lot • Show any propoced grading changes <br /> � • ExisUng a•id pruposed utilities • Show measuremenis M <br /> ��' DO NOT WRITE BELOVJ THIS LIN[ O <br /> 'w' PERMIT CONDITIONS <br /> 1 ' 1.All calls tor inspection shall be made 24 hrs.in advance��hone 259•8810. � � <br /> � 2.All work shall be pedormed in acwrCance wilh this permit and current City of Everet!Desi9n antl Consiruction <br /> Standards and Specifications. <br /> �1 3.Call Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1-500•424•5555. � <br /> �� 4 � 1'I� elevo-�.;u.� �'-{:l�.e. dr ���- coE�k�ue. P�1-.-t �ahz.re. ;a- <br /> ef � ,11�c- ��.�, !l na� be. ntio,e- �kcw. � � <br /> � G��SSet �-�-e, P�P �''� <br /> � 3 v.c�,.�e (niq bte,r �4�. -i�ttix. c e:.�-le,r Lf�� uvF-{�e ���3•+� � � <br /> V+ � <br /> ��' Pq.�� ,�h-ee.-t-• O � <br /> �_� a , <br /> ►_� - � <br /> � <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> ,� � <br /> �7 � The cndersigned owner/applir,ant hereby agrees to hold and save harm� <br /> less the Ciry ol Everetl Irom any and all claims for damages, costs, <br /> ///1 ' �:pens�s, or causes ol action ihat may arise b^cause of installation , <br /> r�/ (�/��,�,¢-1`L(�, j Z� ��r�� and maintenance of the improvement or other righbol�way use herelo I <br /> � C(j-��G � applied lor and further agiees to remove same upon nolice irom ihe <br /> QUProved tor Constructi Dale ty and to replace public property dama thereby. /� <br /> �c�i \I � (� // q <br /> �_� /'i Date /,l�ri�i�/1tifYl�-fi-�- � � /��/l � � <br /> FINAL INSPECTION � Date <br /> Approved as Constructed $ignature ol Applicam <br /> WORK AUTHORIZEC� BY THIS PERMIT MUST BE STAFTED WITHIN <br /> �A�� PUBLICWCRKSOEPAR7MENT 1B0 DAYS OF DATE PERMIT IS ISSUED AND THflREAFTER IS TO <br /> 3200Cedar S1ree1 BE DILIGENTLY PURSUED TO COMPLETION.THIS PERMI7 MAY BE <br /> Everet�,WA 98201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone:259�9810 PROJECT OVER 90 DAYS DURATION. �, <br />