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Date_1Z1�-92 <br />5'"�+-Z�- •4 <br />ApplicalionFor Iil ��'�ISTII��IS- !-C�4i <br />PUBLIC WORK� PERMIT - -- <br />Print or Type Only <br />American Eeta[es <br />Owner <br />Owner <br />Apphcant <br />Describe proposed Work _ <br />4312 127th P1 <br />Mxilmg Adtlress <br />Mailmg ptltlress <br />new house <br />-- � -, <br />Proiec� Adtlress lil known� �J' - 113[h S[ SE <br />Everett <br />Lp <br />Allach lour �4� copies ol plan5 lor proposed woik - Uiaw to scnle antl note !he h'owing as apUhca6le. <br />• Proper�v Linos <br />• OuNine and dimensions ol all eMisling and <br />Pioposetl struclures on the lot <br />• EMisting and proposed ulililies <br />Pu�ec Wonf Pr.m�l • � /�� _ <br />38977 Z -� - <br />B�Jp Oepl • <br />.ee <br />Toulf�e <br />Lesf �Opl fee P�id S <br />BeienceDue f � �/� <br />• Centenine oi sheet <br />• Indicate Norih <br />• Show a.�y proposetl g�ading changes <br />• Show maasurements <br />rnone <br />2 <br />PERMIT CONDITION;i <br />1. All calls Im inspection ehall be mada 24 hrg. in edvance • phone 259•88�0. <br />2. All worr. shall be perfoimed In eccordence with this permit end cu��enl Clly ol Everett Dealgn and Conslruclion <br />SlandaNa and Specilicnllons. <br />3 Call Lowtion Underground Servica 4B hrs. betore you dig, fOLL FREE NUMBER 1•800•424•5555. <br />�', ("�3i1 339' i�k-`� �for �rc -cvnstrut.t��i c:c�ri��. Cnu.. <br />✓ <br />� <br />Approved as Conshucted <br />�/��5 PUBiIC WORKS DEPARTMENT <br />/�-;1 :1200 Ceder Slreet <br />�n Everett, WA 9P201 <br />Phone 259�Bd10 <br />���/�J��- <br />ACKNOWLEDG[MEN7 OF CONDITIONS <br />� <br />O <br />r <br />� <br />O <br />a <br />The undersiyneC oNner/epplicanl he�eby egr?es lo holtl an0 save hnrm� <br />less the City ol Everell Ircm any nnd all claims lor dmnages, costs <br />ezpenses. or causes ol aclion Ihal may nnse ber.nuse o� inslellalion <br />and inainlenance ol the improvemenl or other nghl-of�way use herrlq <br />epN�ed lOr end lurthm agrees to remove same unon nohce hom Uie <br />City and �o repl�Ce p�bliG proP�rty damayed ther�by <br />r � ,` � <br />� �i��`= i. „��_-- -- -- <br />Siynalure ol APh�.cen D.Ve <br />WOPK AUTHORIZED bY fHIS PERMIT NUST 6E STAFTED WITHIN <br />1B0 DAY$ OF DATE PERMIT iS ISSUEC AND THEREAFTEN IS TO <br />BE DILIGENTLY PURSUED TO C06�pLE�ION THIS PERMIT MAY BE <br />CANCELI ED 8'f TH[ CITV UPON ANV STpFPAGE OF WORK ON THIS <br />PROJEGT OVER �0 pA`;S DURATION <br />