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� � � <br />Q � N <br />� � � <br />Hxhi <br />Ki ', � <br />�ii r'I � <br />VJ H <br />C7O� <br />'3 C7 <br />H^�g <br />•.V � <br />9H� <br />y <br />�-i y <br />y <br />r�:] t7 V� <br />!��Crr. <br />H O p� <br />�I <br />7/22/91 <br />Date �'!�'�!�- <br />PUBLI4� <br />�:� <br />Li <br />Print or Type Only `, <br />CJ <br />m <br />NSC PO Box ,3; <br />—_�. <br />OWOCf <br />(11 <br />OWf1eY ni <br />�� <br />/7/ /E=-r -- <br />Applica�ion Por <br />Pu�lic Wo�kS Permil � _��� / / j — . _ <br />uiae oco� • �i��"i1�-27380_- <br />VI�ORKS �l�k�NG ��_Z5_��, P�ero�w���,:`��° G <br />iessAooi FeePam 5 �—Z� <br />O f• r� fi f�1 r�' ;.-) I' r f-� BalanV,Oue $ ��% <br />VI <br />f' '�'': TO Pf1.riTING_ �r—zs-Y� <br />��, l i �� r � d�� ..� ��., <br />vi 4} Ui Il�) ' , (.1 <br />o� ,. ' o u <br />�:d�lin<180U(CBY f� : Y <br />' �J LJ o [bL9 3:'v'_24J <br />"'- Q'- f� O[i i U Gi _> W <br />-� O�T CJ J J.ii G <br />u� i.._ -" a u] L_ Y: :L f_t Ci <br />Nailin9 Address G�y Zip <br />_�esc-ibe ProGosed worh Construct new si�ng_14 family�CSidence <br />Pro�ect Addrass (if known) <br />.333f�— — <br />Al;ach four 1•1) cupies of plans �or proposed work - Draw to scale and note the lollowin9 as applicable: <br />• Properly i.ines <br />• Ouiline an�f dimensions of all exis�in9 �nd <br />propnsed s;�ucWres an ihe tot <br />• Esutir�g and propose:l ctilitics <br />• Cenlerline ol sirect <br />• Indicate Na;th <br />• Shaw any propo,eA gradin9 chan�c: <br />• Show rneasuremeris <br />BELO+A' <br />Nnone <br />Fhanc <br />P!cFC11T Cf.;':r: i i�; fd6 <br />t all r,sus •� ���.��scecti,nr s� sll t�� m:,d�: ?�� ���:. in advsnce � phone 259-8810. <br />;?. t,ll �xerk _�� �di be perforn ed m an�o•earie; m�th ihis permit and current City of Evereti Oesign and Construction <br />;Sta�idai:t•: and SneGlicat�ons. <br />3. i.all Lor.a�i;n Under�round S�:rvice a3 hi; belore you dig. TOLL FREE NUMBER 1•800•424•5555. <br />�!..�',�. , , / 1i,.. <br />f �.7/.2.C�.'ecc�c.t/ G.-L'"L �tj?�.� /ji:xtXl,c.C� .nct.i./ <br />iJ <br />�t,rr-.� 6 <...r � c.,t�.ti.L�'•G �f/iu �,E ��� � � <br />/� rd L!' <br />Y3/8 - %�- a�r. SF- � <br />c< <,���,,.f •��.til� ,-z::;�:•� ���" 9�i6 <br />� - <br />_�i.�:/j r�[72'1!?�. .i —?C' ' /� <br />Approved f �Consiruc�ion � Uate <br />� / t. ��:..: . / � � S. I <br />/ i s .! �� � <br />FIN IIJSPECTION � -�� �� I <br />Approvetl as Conslructed <br />evere[t PUBLIC WORKS DEPARTMEN7 <br />� 3200 Cetlai Sireet <br />Everett. WA 98201 <br />Phone:259-8�10 <br />�2t.(t��.1i,F; t/, <br />��-�fc�t� �• <br />•����., , S — <br />—..�•�� r. <br />ACKNOWLEDGEMENT OF CONDITIONS <br />Z <br />� <br />♦�^ <br />v♦ <br />�/� <br />W <br />Thi� undersignetl owner/appiican� hereUy agrees �o hold and save hanm <br />les, ihe City of Everetl Irom any and all claims lor dama9es r.osts. <br />expenses. or cause � cl action that may 2nse because of inst:+�lation <br />ana main�enance ol the improvemenl or o!her nghPo�-way use h�eretr <br />applieA for and fur�her aqrees �o remove same upon noti��.,�� trom Ihe <br />�ib� and lo replace public property dama eA Ihercby. <br />f <br />7:'� l <br />%� =� �_c.-. ��C� l�� � <br />SignaWre ol Appllcan� ���� <br />WORK AUTHURIZED BV THIS PERMIT MUST BE STARTED 1NITHIN <br />180 DA'iS OF DATE PERMIT IS ISSUED AND THEREAPT[R IS TO <br />BE Dll IGENTLY PUPSl1ED TO COMPL[TION. Tb{�g pEH�11T PdAY BE <br />CANC[LLED BV THE CITY UPON ANY SIOPFAGE OF WORh UN THIS <br />PROJECT OVER 90 DAYS DURATION. <br />