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� <br /> r � <br /> DBtB�-��6/ v�m�c won.v..mn• gy//�^ <br /> B�eO OePt ♦ � � ��� // <br /> Applicalion Fo� — <br /> PUBLIC WORKS PEFiMIT °°°T;:�F:`°• • ao. � � <br /> �� <br /> � <br /> L�o�OCI i�e P�iO � � <br /> e.i.��.o�. s a O o <7 <br /> Print or Type Only �9g',z `� <br /> ����f' � ��kQ,� �oo � �[3A�P� F t— �a�i a.sa- s:��9 <br /> Owner <br /> Mallinp Addreas Cily Zip Phone <br /> hl e CitY ZiP Phone <br /> Applicant Mallinp Addrn6s <br /> � _ � � ,�� F ���7�cd � '. _ <br /> Deecribe Propoaxd Work '—'T <br /> ��d� ,ap a .s�rtJ�� <br /> W <br /> P✓ � <br /> Prolect Addreae(il knowo) <br /> � <br /> Adach lour(4)coD�ea ol plene lor proposed work- Draw to scale and nole ihe lollowing as apphcable: � <br /> • Property Lines • Centerfine of streel <br /> • Outlina end dimenslone ol all ezistinp end • Indicete North <br /> propoaed structu�ee on tha lot • Show eny proposed grading changes <br /> • E■ialing and proposed utlllliea • Show measur��.nenls M <br /> W <br /> �� DO NOT WRITE BELOW THIS LINE O <br /> PEFIMIT CONDITIONS � <br /> 1. All cells lor inspection ahall be made 24 hra. in advence• phone 259•881 5. <br /> 2. All work Bhall be parlormed In eccordance wilh thls permil and currenl City of Everelt Design and ConsVuction <br /> Slendarde end Specllicatione. � <br /> 3. Coll Locallon llndarpround Service 48 hie.belore you dig.TOLL FREE NUMBER 1-$00•424•5555. <br /> O <br /> �w <br /> �/ <br /> ., � <br /> � <br /> ACK�IOWLEDGEMENT OF CONUITIONS <br /> The under5ignoJ owneqaPPlicant hereby egrees lo hold antl snve harm� <br /> loss Ihe City ol Everetl Irom any end all cleims for damages, costs, <br /> �/J exponses, o• causes of aclion ihet may erlse becausa of inslallaUon <br /> �` and mnm�enan�.^ of the improvemenl or olher righPof�wey use heroto <br /> -i�'c='%���/�G'G.� s. /6 - �'y aPVlied lor entl furihnr a9rees to remo�•e sama uPon noUr.e Irom Ihe <br /> �=�_ <br /> Approvatl lor Construction ! Date City and to�eplace pu6lic property damxped theraby. � <br /> � � <br /> �//—' _QS��� �`• i-<J' � - ��� ^✓ S/a 9/Jf <br /> / Dele !-,F � <br /> � FINAL INSPECTION , ignature ol ApplicMil � Date <br /> Approved ee Constructed <br /> WORK AUTHORIZE� BV THIS PERMIT MUST BE STARTFO WITHI <br /> everett PUBLIC WORKS DEPARiMENT 180 DAVS OF DATE i'EiiM1T IS ISSUED AND TNEREAFTER IS TO <br /> � 3200 Cador Sireel BE DIU(;ENTLY PUNSUED 10 COMPLETION. TNIS PER411T MAY BE <br /> Everott.WA fl8201 CANCELI.ED BY 7NE CI7Y UPON ANV STOPPAG[-OP VlORN ON 1HiS J <br /> Phone�. 259-6815 PROJEC7 OVER�d0 DAYS DURAI�ON <br />