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{Z ��•2q•5 / <br /> � APPlication For <br /> PUBLIC WORKS PERF+�IT �a�e 11-�2-�6 <br /> PUBLIC WORKS DEPARTMENT Public Works Pertnit p _ � Z. ___ <br /> 3200 Cedar Slreet <br /> Eve�etl.WA 98201 259-8870 Buil6ing Permit N 53580 <br /> '`! �'�STIMG ocr 1 z �sse .-, �G <br /> TYPE OFi PRINT ONLY + .. Pubtic Works Fee 5 -'- b `� <br /> Vladimir Arieff 9257 College Way N Seattle IdA 98103 523-1082 <br /> Owner Mailing Addrass City Lip Phone <br /> Owner <br /> Applicant Mailing Address City Zip Ph.ina <br /> Uescribe Proposed Work new house � <br /> r <br /> V♦ <br /> PROJECT ADDRESS (if known) �� �� �3+h .�tv�t � <br /> Attach four(4)copies of plans for proposed work-Draw to scale and note ihe following if applicable: Q <br /> •Property Lines •Outline and dimensions of all existing and proposed stmcWres on the lot °Exisiing 2nd proposed utilities <br /> •Centedine of sireet •Indicate Nohh °Show any proposed grading changes •Show measuremenis � <br /> DO NOT WRITE BELOW THIS LINE <br /> PERMIT CONDITIONS: �J <br /> 1.All calls fur inspection shail be made 24 hours in advance- phone 259-8810. �� <br /> 2. All work shall be performed in accordance w!th this pe�mit and current City of E�erett Design and �] <br /> Construction Standard� and Specifications. �� <br /> 3. Call Location Underground Service 48 hrs. before yeu dig. TqLL FREE NUMBFR 1-800-424-5555. `— <br /> ,/' /7 r <br /> / i �.Cf.KLG£LC-� [-G.riC-C'lr�a� � /2' /i/0'J"�. CLL'v_P�C.� :?I�t7.�4fi _��I;'; ^11f�!'�.::V�. � �/ <br /> � �, � <br /> av ��z✓�� Div �v�.L���l'c7{�(o�; � __ , <br /> c/a� /?-/o -9� .�ooasseo a <br /> ELDu 5iQ�, 'c <br /> PLF6 46-:.;:3 <br /> "ECN 860,;i: <br /> Ss:CtisG 4-' .=,, <br /> )R.iVWi' 3^O,L� <br /> � <br /> HJ00304�5 <br /> S=WER S^^.;:0 <br /> �,_.-rr ,q�� �-� <br /> _.,.. ..�. _,. <br /> � <br /> '� <br /> �a� <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> �/� � � The undersigned owner/applicant hereby agrees to hold and save harmless <br /> � � the Cit ot Everett from an and all claims(or dama es,cosis,ex enses,or <br /> �`�r � . � /G causes of action ihat may arise because of installa9nn and main�nance of <br /> pprove � Con/stm� �ate theimprovementorotherright-of-wayusehzretoappliedfoiandluriheragrecs <br /> �iC/ to remove same upon nolice from ihs City and to replace public piopedy <br /> ��� . �_ � - 5'7 damaged hereby. <br /> FINA "I—SPECTION' Dale �/� , i <br /> Approved as Consiructed � //'GL� �, � <br /> CGC �jf%l/I <br /> �--- Signature of Applicant Date <br /> WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN 180 DAYS OF DAT[PERMIT IS ISSUED AND TNEREAFTER IS TO B. E f� . Y PURSUEU TO <br /> COMPLEfION.THIS PERMIT MAY BE CANCELLED BY TNE CITY UPON ANY STOPPAGE OF WORK ON THIS PROJECT OVER 90•B3t�f5�RATION. <br />