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��x <br />C y <br />H�� <br />H �1 <br />��q H � <br />y <br />Hx <br />OHd <br />��g <br />(�]Y (i <br />t"y� <br />HH <br />g � �� <br />� � y <br />HON <br />Date �i—�s—nl <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Typo Only <br />v�mec wa��e aermn. <br />emu neoi • 91 �$�25 <br />Puei�cWo��afeo 5 <br />TO�TIi[P <br />�.�snani �e�v,��o S <br />a,i.��oo�e s <br />ROBERT LUDWIC 7304 BEVERLY BLVD EVERETT 98203 355-7369 <br />Owner MailingAtldress Ciry Zip Phone <br />OWNER <br />Applicanl Mailing Address Gily Zip Phone <br />Describe Proposed Work STORAGE 6 GARAGE _ <br />Projecl Addross (ii known) <br />Attach lour (4) coples of plans lor proposed work - Draw to scale and note the lollo�vin� as applicable: <br />• Proper•y Lines <br />• Outline and dimensions ol all existing and <br />proposed siructures on the lot <br />• Existing antl proposed utilities <br />• Centrdine ol street <br />• Indicate North <br />• Sho�v any proposed grading changes <br />• Shew mea5uremEniS <br />PERMITCONDITIONS <br />1, All calls for Inspec�ion shall be made ^<4 hrs. in advance � phone 259•8810. <br />2. All work shell be pedormed in acwrdance with this permit entl eurrent Ci�y ot Everelt Design ond Constmctio� <br />Standerds nnd Specilications. <br />:i. Call Location Underground Service 48 hrs. belore you dig. TU! L FREE NUMBER 1•800•424•5555. <br />/ �/df�l�G L�.�C�2�� �:2,)rll.f / "• � ��!!-lL.O" <br />� ZO rf� <br />Approved lor Cnnshuclion D�te <br />FINAL INSPECTION ��1e <br />AOO�oved as Constmc�ed <br />��r�PUBLICWORKSDEPAR7MENT <br />3200 Cedar Slrent <br />Evorett, WA 90201 <br />Phone: 259�8810 <br />ACKNOJJLEDGEMENT OF CONDITIONS <br />W <br />� <br />s <br />r / <br />The undersigned owner/applicant hereby agrees to hold antl sar^ harm� <br />less ihe Cdy of Everetl Irom any and all claims lor damages, costs. <br />expenses. or causes ol action Ihat may arise because ol installation <br />and maintenance ol ihe improvement or other righ��ol�way use herelo <br />applied lor and lurlher agrees lo remove same upon notice Irom thc <br />City and tu replace public property damageA Ihereby. <br />Sic�na�ure ol APplican� Date <br />WOPK AUTHORI2ED BY iHIS PERA'IT MUST BE STARTED \YITHIN <br />180 DAYS Of DATE PERMITIS ISSUED AND THEREAFTER IS TO <br />BE DILIGENILY PURSUED TO COMPLETION. THIS PERMIT M11AV BE <br />CANCELLED BV THE CI7V UPON ANY STOPPAGE OF WORK 01� TIiIS <br />PROJECI OVEP 30 DAYS DURATION. / <br />\/ <br />