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r «� <br /> � <br /> Date �'�� � r Pv�llc WOM1e Permit• <br /> App�ication FOr BICB�Deol.� h'.3.��13 7 `T <br /> PUBLIC WORKS PERMiT P�mrcWorWFee <br /> Totel Fee S <br /> Les�Apo�Fee Pa1E .S <br /> Print or Type Only <br /> B�Ian<a Oue S � <br /> � <br /> � <br /> �.1c���fr.�r l.,�n ,�'� ��,A� 7f"�� ",A,����'�-. �9����>� <br /> wner Txiling Ad ress City Zip Phone <br /> ���/.�-1,�/���/-�iz T�� /"l��/�`���—�-�1r� `�Yf3'ZDr� .?�9 , 67 � <br /> Apnlicant �iling Address City Zip Phone <br /> yscribe ProPO ef, d V✓ark I ��f' / '��9*�'7" ��-�'—� �J=1�� �' - /Mr• � <br /> �� '1ri�7 <br /> W <br /> Project Address(i1 known) � <br /> Attach(our(4) copies o1 plans lor proposed work- D aw to scale and note the following as applicable: � <br /> • Property Linec • Centedine of street � <br /> • Oulline and dimensions of all exlating and • Indlwle Norih <br /> proposed structures on the lot • Show any proposed grading changes <br /> • Existing and proposed utilities • Show measurements � <br /> DO N07 WRITE BELOW THIS LINE O <br /> PEkM1T CONDITIONS <br /> 1. All calls for inspection shall be made 24 hrs in advance•phone 259-881 5. � <br /> 2. All work shall be perlormed in accor�ance with this permit and wrrent Ciry of Everetl Design and Conslruction <br /> Standards and Specificalions. <br /> 3. Call Location Underground Service 4B hrs.belore you dig.TOLL FREE NUMBER 1-800•424•5555. � <br /> n � e � <br /> �� I � 1'ErN, �'}' I`Pju�rr� O <br /> n �vo ��` ' <br /> N �" '` ----- -- <br /> C .._--.__-__ <br /> -- ff� t�[Y'1 'v� o'� � v Slde �.��nl� c9f ah� � <br /> � � ��� � � <br /> S �feo {� �t r�� u �n �� � �r��. w. �l w,us }- N <br /> � <br /> ,ov '�( /� O <br /> �O � f� �r/ �''i �Y-h �a /��C��n u� �r �fnpo5�d! �,,.F <br /> � � ' , <br /> be ``� �„ �l, wi,,s.h �O c c;f p.ti� F.D b'� �,e � <br /> y�+ 1 <br /> L�U��<<� �Na � � <br /> , � � �IlJISiOn . <br /> '� ��`� _ " 2 <br /> �/� '`f-� �J <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees to hold and save harm� <br /> less Ihe City of Everelt Irom any and al� claims for damages, costs. <br /> expenses, or causes of action that may arise because of instaliation <br /> and maiMenance ot the improvement or other right-o4way use hereto <br /> ApprovedforConsLuction Date applied lor and lurther agrees to remove same upon notice Irom the <br /> City and to replace public property damaged thereby. <br /> L FINAL INSPECTION Dnle r <br /> Approved as Consiructed Signature of Applica.�t Date <br /> everett PUBLIC WORKS DEPARTMENT �NORK AUTHORIZED 8Y THIS PERMIT MUST BE STARTED WITHIN <br /> � 3200Cedar51ree1 180 DAYS OF DATE PERMIT IS ISSUED AND THEHEAFTER IS TO <br /> Everetl.WA 98201 BE DIIIGENTLY PURSUED TO COMPLETION.TliIS PEFIMIT MAY BF <br /> Phone:259�8815 CANCELLED BV T'IE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 9tl DAYS DURATION. <br /> L J <br /> ' ! <br />