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� <br />� <br /> r � <br /> �bte�� PuEucWort�Pamil• C7y-- ,GJ�..� _ <br /> Applicalion For eiay oeo�.• �, �3�__ <br /> PUBUC WORKS PERM17 PubTol�Fe�F•• : -- _ <br /> ��u�oo�.vu v��a 6 — <br /> e�b�c�ow 3 �C �L� � <br /> '� Print or Typa Only <br /> �/SSO <br /> eNV�iS , � �ni �1813 (3wyv �iu �a..t Lv�GcC� .�$�103 '3S3-8o�_ <br /> Owner Mallinp Addresa Cily Zip Phone <br /> /� << « �� /� _ <br /> Appllccol Meiling Address Gty Zip Phone <br /> Deecrlbe ProGasad Work <br /> �OL7f'PS�I�f[� C[/UO Q� �' �•'O�[.tp � � �.�-J� f--S��� <br /> �� ' ��r�c� <br /> - -T�.--.-- W <br /> Fro�ect Addrees(II known) �- ��'�� n��w��k C�� ��'�. � <br /> Attech lour(4)topies ol plen8 tor proposod work- Draw to e^_ai�� and nole�he Icllowing as applicable: �� <br /> • Pioperty Linee • Con�erlino at stree� � <br /> • Outline and dimenalons ol ell existing and • Indicate North <br /> propo8ed structures on the lot • Show any proposod greding changes <br /> • Exiellnp and proposed utilitiee • Show measurements � <br /> DO NOT WFITE BEIOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 5. All cells lor Inapect��n shall bu made :4 hrs in advance- phone 259•881 5. � <br /> 2. Atl work shell be pedormed in accordance with Ihis perm�t and current Cily of Everelt Design and Conslruction <br /> Standarde and Specllicatlons <br /> 3. Call Locatiori Underpround Service 4B hra. belore you dig.TOLL FREE NUMBER 1•800•424•5555. � <br /> O <br /> � <br /> N <br /> O <br /> a <br /> ACKNOWLEDGEMENT OF CONDI110NS <br /> The undersigned owner/applicant hereby agrees to hold and save harm- <br /> less the Gity ol Everett Irom any and all claims lor dameges, cosis, <br /> expenses, or causes of sction tha� may arise becausa ol installation <br /> � s ,� -� � � and maintenance ol Ihe improvement or othei npht�oi-way use hereto <br /> t/S ���ri1�� � � applied br and further agrees to remove samo upon notice trom Ihe <br /> Approved lor ConsVudion a�e City and to replaca public properly dameged Ihereby. <br /> ���� <br /> r 1 - ,- 1 -�r _ � � ..L ���Y�85� e <br /> FINAL IN9PECTION `�a�" <br /> ApOroved as Construc�ed Signatwe ol Applicant Date <br /> WORY. AUTHORIZED BV THIS PERMIT MUST BE START[:D WITIiIN <br /> everett PUBLIC WORKS DEPARTMENT 18� DAYS OF DATE PERMIT IS ISSUED AND TtiEREAFTER IS 10 <br /> � 3200 Cedar Sireet BE DILIGENTLV PURSUED TO COMPLETION. TFIIS PFRMIT MAV BE <br /> Everetl,WA 98201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON TIPS <br /> Phone: 259-BB15 PROJECT OVER 60 DAVS DURATION <br /> ` J <br /> �_ - <br />