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FIT <br /> evertFil <br /> I Q APPLICATION FOR RIGHT-OF-WAY USE PERMIT <br /> �j Type or print clearly with Ink C <br /> PRESS HARD- YOU ARE MAKING COPIES APPLICATION FOR <br /> /'1 everetl <br /> PUBLIC WORKS PERMIT NO. 3.33 1haErarpnan O N ST R l! CT I O N e <br /> EVERETT,WASHINGTON CITY or Z <br /> APPLICANT(UNDERSIGNED)AND FIRM REPRESENTED, IF ANY:-� everett PERMIT <br /> ^�� /S r Y) _ 11.. . DEPT AL COMMUNITY DEVELOPMENT SERVICES <br /> HEREBY APPLIES FOR PERMISSION TO._.5� LC.1�-x'L- ...PP.�"""`^^^""""""���� CITY HALL 254B7A5 <br /> EVER[TT,WA9BZ01 C]COR181NATION ❑ BUILDING ❑MECHANICAL ❑PLUMBING PERLE, IT N <br /> IIP PHONE <br /> O �R pNi <br /> S � G —� .�('{M��- � OwNIK �1 .M�N ADONIS 5 .{ll, y7' I (��L-_3 '' .s -� �-- ` <br /> • /J.Iiti ( IARCH <br /> 1 l , <br /> r .HDNL <br /> , <br /> AT THE FOLLOWING LOCATION A — ARCNC <br /> OA Oq N MAn eooptss <br /> VYL i it i7ic J <br /> 4{-x'1 C I 2 P rNONL IICI NSI f <br /> MM AD It SS <br /> DRAWING (WORK TO BE DONE) OR THREE PLANS ATTACHED: GINIR/ll'rnNIAAC^OK' � (I,r rIP rNONI LICENSE <br /> A /W <br /> Nil HANI(AI coN,RAC1oK n Dplss <br /> MAIL ADDRESS <br /> cIp lir rnoNl uclNse a <br /> GOND ITIONS PIUMRIN,,CONIXA:,OK R 1 <br /> (,ASS Or WORK GARACE []BUILDING RELOCATION <br /> r1 C1NEW ADDITION ❑ALTERATION EIRE PA R ❑OFMOIITION ❑FENCE ❑SIGN M <br /> 1 <br /> � That portion of the driveway within the right of way must be paved. v„UA,IONor WORK <br /> 1 , <br /> IPower of attorney required. CIS(RIBI WORK <br /> PROPO ITUSE of a n Nc , 1 HEREBY CERTIFY THAT 1 HAVE READ AND EXAMINED THIS AP. <br /> Il � L _ ) PLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br /> /` <br /> t �_ PROVISIONS OF LAWS AND ORDINANCES GOVERNING PHIS TYPE <br /> IIGQ nISCRnTIONof PROM IT OHO es W OR ATTACH 10 Pit1) OF WORK WILL NE COMPLIED WITH WHETHER SPECIFIED HEREIN <br /> {--"9 C" OR NOT THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br /> �.p,ocRor GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br /> ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br /> /� �•� OR THE PERFORMANCE OF CONSTRUCTION. <br /> SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT DATE y <br /> ADDRESS -L �c X <br /> PIUM►IH••-•�^ MECHANIC l <br /> TYPE Oi EQUIPMENT iFF <br /> /Y FEF NO. <br /> NO, TYPE OF FIXTURE <br /> II ==ND UN115-NPU — <br /> /� �! WAiIR CIOSIT If OLll 11 pF iRIG[RATIOH UN't5-HP U <br /> LATBOIL REDA EA <br /> /' IV <br /> LAVATORY <br /> F <br /> Y(WASH BASIN) LAS FIRED AC GNITS-TONNAGE EA <br /> r / SHOWER IORCED AIR SYSTEMS-BTU MU <br /> KITCHIN SINK b DISP WALL HE ATERS-B 7 U M <br /> 1 DISWASHFR UNITHIATFRS-RTU M <br /> LAUNDRY TRAY lVN`OpATIVF COOLERS <br /> CLOTHES WASHER — CLOTHES DRY[RS <br /> WATER HIAIE” VINTIIATION IAN ` <br /> URINAL <br /> DRIVEWAY SEC110N I RANGE Hoop <br /> PRINKING FOUNTAIN AIR HANDLING UNIT- <br /> 1 FLOOR DRAIN STOVE N <br /> PERMIT IS VALID FOR 60 DAYS {� VACUUMA5 ME IAL IIRI PLACE bC111MNEY <br /> R0O <br /> _ ROOf DRAI pRAINS-RAINLI AOFNS <br /> l [ON <br /> OPY OF THIS APPLICATION TO BE POSTED �` ( I" LIP � SIM,ISIRVICI- BAR ITC) <br /> JOBSITE. 3011 X30" <br /> CALL FOR INSPECTION 259-981 1 <br /> 24 HOURS BEFORE CONSTRUCTION suatoul + <br /> The undersigned owner hereby e9rees to hold end save s COSTS. <br /> SUS 10,AL + <br /> The City of Enroll from any and all Clalmt for damages COfI+• PERMIT <br /> expenses,or causes of action that may ansa because of installation PERMIT + TO 11 1 + <br /> ( eno maintenance of the Improvement or other right-of-way use TOTAL F!! + <br /> herelo applied for and lunhef agrees to remove same upon notice STREET SETBACK NI AP YApO 51 BACK <br /> • - <br /> I+ from the City and to replace public property damaged therebySIDE YARD WRACK. I } PIAN CHECK NUMBER PLAN CHECK iFl <br /> Flt RECEIPT NO <br /> I _ E-rf b'` 5 /J <br /> ( DEPARTMENT APPROVALSFI! <br /> 1,51 ZONE LOT AN VACAN74SIll IEVALUATION <br /> Is <br /> yNts ONO <br /> COMMUNICA71ONS OCCUPANCY GROUP NO OF DWELIINL UNITS <br /> SEWER <br /> 1Y'Pt OI CONS <br /> BUILDING .l r_ <br /> .Ralru; n /f l /J NO 01 SIORIlS MAR OCC LOAD <br /> DRAINAGE (/ F // Y• SLZE O1 BLDG <br /> n wT Com{' Ci•i � PLUMBING <br /> WATER PI IlNN1 SIGNATURE Of APPLICAN• rn, ,,��II <br /> /� �// A. I LIR[ ZONE flASE MF NI RI UXE H)M5 flRf SPRINKLERS MICHANI(Al <br /> �-W RIQUIR FI <br /> 7YIS FIND <br /> ADDRE55 DATE 07H1" <br /> AMOVAIf fY <br /> UBC <br /> ST.•EEI <br /> CITY IIP 1 ENVIRONMENTAL CN[Ck LIST PINAt TV SEC IORRI <br /> A V -( .��) Y • 7 D E 3s - o�y6 337-5�70D I BUILDING PLANS •� T" " <br /> 1 TELEPHONE NUMBER AITEFINATI <br /> TOTAL <br /> 1." W DUdll1 <br /> T a i>il0 5> �� �pO — 4 jtH HYDRAH - <br /> --'rT/—� /J D PERMIT VALIDATION <br /> DME A 110.1 P� P�1EC�IL V SYSTEM WIIIH PROPULY VAIIUATIDDN THIS SPACII IHIS 15 YOUR PFRMIL <br /> R VED A�fRUCTED -- DATL 1, `. I <br /> S GLAUINLII RC AVAIIONbCII ARINLIGRUNRING <br /> CONSTHIJCIION/AS BUIL FEE 1978 a DRAINAGE <br /> INVII'.ONMF NIAL IMPACT'StAIf HENT - <br /> h -t ALTHDIS7RICT <br />