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ltBg�� ' PueOc Work�POer�mil�/� �� - <br /> Appliwtion For Biap.Dao�.•Il3J � � �� <br /> PUBLIC WORKS PERMIT P�oto;��eeF�� : �o. 00 <br /> Lees RpO�Fee Ge10 S �j � <br /> Ba��n<e oue S_!�"�•� � <br /> Print or Type Only 6 y�a.� <br /> �':. .��.� 8 �� y`✓PTI Hvrc� ��sT.. P� ' �?o'P� 9Pi.�03 � S�o '� 3� Z <br /> Owner Mailing Address C:ity Zip Phone <br /> �/�'l•P <br /> Appllcanl Mailing Address City 2ip Phone oz <br /> �'- -1 <br /> _ 1 <br /> Dnvcribe Pruposed Work ^✓�g Cd'rcv�o � ^� � � � m <br /> .. .. <br /> -� �7 <br /> _ � •-' --1 <br /> VI 2 <br /> m <br /> Prolect Add�ess(il kr,own) �2 Z � ^N� � �^� <br /> Atlech Ic��r(d)coples ol plens lor pr^posed work- Draw to scale end note tha lollo�vi�g as applicable: � 0 3 <br /> s Prope�ty Unes • Conterlins oi streat � m <br /> • Oulline and dimanaions of ell exiating and • Indicate North m� <br /> proposed atructuree on the lot � ;hc�w eny {��oposed grading chenges � <br /> � Existing and proposed utllitles • 5hc.a measurements M c <br /> W � _ <br /> DO NOT WRITE BELOW THIS LINE �y� <br /> PERMIT CONDITIONS O p � <br /> 1. All calls lor Inspection nhall be made 24 his. In advance•phone 259•8815. '� <br /> 2. All work shell be Feriormed in eccordar.c=wi�h thie peinit and curren!Clry of Everett Design anc Cor..lructlon � _ <br /> Standerds end Speclficatlons. m� <br /> 3. CaII Locetion Underground Service 48 hra.belore you dig. TOLL PfiL'E NUMOF.R 1•BOO•424•5555. � �^ <br /> '� 1N E*�. II ,�L„ CO.�C �NIVG1C+ �0�r7t \n r)•� , \NC N�+�V nN <br /> O m N <br /> �f\Jtww� U'O�f�.1� ` <br /> Z C7 <br /> � (' , 1 .�m <br /> S' pOr� •Or� O? �� ���rCWw� v�4+���+ `��t �wti`��. 1CIw � a <br /> 1 A <br /> MK1� �f�.. ��LV !� � � "� <br /> S <br /> s <br /> z <br /> � � <br /> � <br /> N <br /> � 0 <br /> � <br /> n <br /> m <br /> ACKNOWLEDGEtdENT OF C.ONDITIONS <br /> The undersigned��wner/applicant hersuy agnfes to hold end seve herm- <br /> - �I less tne City ol �Eveielt irom any and alf claims lor demagea, costs. <br /> � eMpenses, a causes of a�tlon that may arise beceuse ol Instaltatlon <br /> �� �83 and mainienance ot the im�rovement or other righ�•o�-wny usn here�o <br /> _ applied for and lirfhe� agrees lo remove same upon notlCe from the <br /> oved for Construction �, Dale City and to reFlace public proPerty dameged themby. <br /> �—''� ���L�� �-� I F� '��y 1f�Jr_� ` <br /> AL INSPECTION Da�e ��L � � <br /> Approved as Constructed 3� el a ol App can! 1 • � Date <br /> everett PUBLIC WORKS DEPARTMENT WORK AUTHQRIZED BY THIS PER611T MUST BB STARTED WITNIN <br /> 180 OAYS OF CATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200 Cader Street BE DILIGENTLV PURSUEU TO COMPLETION. THIS PERMIT MAV BE <br /> Everett,WA 98201 CANCELLED BV THE CITV UPON AN1'STOPPAGE OF WORK ON THIS <br /> Phono: 259�8815 pROJECT OVER 90 DAYS DURATION. <br />