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i <br /> I <br /> i <br /> � � <br /> `'') �'� Q � _ <br /> Date�LJ�M Publ¢Worb Permil• � <br /> m Applicelion For eieo oeo��• — <br /> PU�LIC WORKS PERMIT PubTotelFeeFee s <br /> � <br /> � Les�Aool Fee veia S <br /> O <br /> rj BSlanceLue 5 O� <br /> Print or Type Onl� q� <br /> 00 <br /> F9 OJ fJ <br /> ,r M,�,, '/ �{�� <br /> —�A�� L°�- �C�KM,� �7.� l�-N-f'r///.°��dllt' ,�<�- �a P 3 .3 y��s�� <br /> Owner a� � �� Ma6inB Address Cily 2ip Phone <br /> r; <br /> CJ O 1—Q <br /> — �12� � � $U <br /> Applicant Mailing Address City Zip Phone <br /> Describe P�opo3etl Work ��/ �i_/C�Sd.� ����'' ��S��ti j� ��'� 3�� UC�'/, <br /> -- Y' r' �� 'TY`�Gv1 c/n ,�1-. weE. (�,,,.,d,_ � <br /> Pro�ect Address(if known� _y_7��� � � <br /> � <br /> 4ttach four(4)copias ol plens lor or000sad work- Draw to scale and note the lollowing as applicable: � <br /> • Property Linos • Cente�line ol sireet � <br /> • Outline and dimensions ol all ezisting end • Indicata Nor�h <br /> pr�posed atructures on Ihe lot • Show any proVosed grading changes <br /> • Existing and proposed u�ilitins • Show measuremenls � <br /> DO NUT WRITE BELOW THIS LINE <br /> PERMIT CONDITIOMS O I <br /> 7.All cells for inspectlon ahall be made 24 hrs.in aAvance•phone 259•8810. � �' <br /> 2 All work shall be pertormed In accordence with ih�a permit end current City ol Everelt Design and Construction <br /> Stendarda and Specificatlons. <br /> 3.Call Lxatloo Undon,�tound Servlce 48 hrs.before you dig.TOLL FREE NUMBER 1•800•424•5555. � ., <br /> O <br /> � <br /> � <br /> O <br /> a <br /> ACKNOW�EDGEMENT OF CONDITIONS <br /> � �-�lZ �..�N�G��� � �k-�'r^�S ���k The undersigned owner/applicont hmeby agrees to hold and save harm� <br /> — less the City ol Everetl irom eny and all claims for damages, costs, <br /> ezpenses, or causes ol action that may nrise because of installation �,, <br /> - � � (� I��C �'�,— � ���_�� and maintenance of Ihe improvnment or other right-of�way use hereto I <br /> -��- f _— " —j_ applied lor and lurther agrees to remove same upon notice irom Ihe <br /> AUProved lor Con;drycGon / Dale City and lo ieplace public prope�ty dama9ed Ihereby. �, <br /> j�/�.�[/ � � �7 � C� <br /> _�L1�'�.:i� !—�_�'_ �U ��/_�/ / ��—( � <br /> FINAL INSPECTION Dale '� <br /> Approved as Conslructed Si ature ol Applican� �ate � <br /> � WORK AU7HORIZED BY 7HIS PERMIT MUST BE STARTED WITHIN I <br /> ,�M� PUBLICWORKSDEPARTMENT IBO DAV� OF DATE PERMIT IS ISSUED PND THEREAFTER IS TO . <br /> 3200CederStree� BE DILIGENTI.Y I'URSUFD TO COMPLETIOA. THIS PERMIT MAY BE <br /> Everett,WA 98201 CANC[I.LED BY TNE CITY UPON ANY STQPPAGE OF WORK ON THIS I <br /> Phone:255�BB10 PROJ[CT OV[(7 90 DAVS DUFATION. � <br /> � <br /> I <br /> I <br />