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_ ,,^+�,,^4a;K i rT �; _`v 8 i,,.u:t'.; . e �._. <br /> . . ' � . < .Y ^ . <br /> . �/� �', Y}}. � . . . <br /> _Y::'kC+'i!�!t j...,. <br />� ' . . . . . . .. <br />_ � �1 <br /> Date_� P�n�,�wo,k.ve,m��. — <br /> BiaB Dep�.+��f/�-�-��-- <br /> Appiicaticn For <br /> PUBLIC WORKS PERMIT PubTo�Fee`Ce S <br /> les5 APO��Fee Vaitl $ <br /> BalancP�uC S <br /> Print or Type Only <br /> �y l ('r �a P r /N/5 b' rrD�iin,� .E�e i�1� Q�"oZD/ oZ S4-�o(oG6 — <br /> � �N,ef Mailing Address Cily LP Phone <br /> II Sn��I <br /> AppGcant Mailmg Address Clty Zip Phone <br /> Descn�e Proposed Work r ����� �'`^��� �� � � ��� ��—n� �r � <br /> - W <br /> Projecl Addre=s Iif known) <br /> �s � �•- <br /> Attach tour 14)copies ol plans for proposed work• Draw to scale and note e lollowing as applicable: � <br /> • Property Lines • Centerline of street � <br /> • Outline and dimensions of all existing and • Indiwle Norih <br /> proposetl slructures on the lot • Show any proposed grading chanc7es <br /> • Existing and proposed ulillties • Show measurements M <br /> W <br /> DO NOT WRITE BELOW THIS LINE O <br /> PcRM1T CONDITIONS <br /> 7.All calls for inspeclion shail be made 24 hrs.in advance•phone 259•8810. � <br /> 2.All w�ork shall be peAormed in accordance with this permit and wrrenl City ol Everelt Design and Constmction <br /> Standards anA Specitications. <br /> 3.Call Location Undergroiind Service 4l�hrs.before you dig.TOLI FREE NUMBER 1•800•424•5555. � <br /> �UBL/C /�v��-f f%r�2MiT �oT 2.�Ft�Ui.e�l� � <br /> Fi2 �iAQAG£ `i'ODiTioit/, � <br /> /j�gW�d�'.�� f�,�Mi% GJiLC � �'�EQvi.�'L=� ♦/� <br /> �,� f�Gi.t/G OF f�iA,e�/it/G L D T ��� <br /> AF:E� �/s�' �'��n'•i r�/irr/ Q <br /> �C�Nn/j�/rr-I�iFPT �S 1SSd�� � �Q,� a <br /> �/jO�,. <br /> g.,� -89' <br /> ACKNOWLEDGEMENT OF CONUITION3 <br /> The undersigned owner/applicant hereby agrees to hold and szve harm� <br /> less Ihe Ciry ol Everelt Irom any and all claims lor damages, costs. <br /> ezpenses, or causes ol aclion ihat may arise Uecause ol installation <br /> and maintenance ol lhe improvement or other righbo4way use hereto <br /> applied lor and Wrther agrees to remove same upon notice Irom tiie <br /> Approved lor Conslruction Date City and�replace public p ity aged Ihereby. <br /> Date � � .�� � � � <br /> FINAL INSPECTION gna�ure ol App ca ate <br /> Aporoved as Construcled <br /> WORK AU7HORIZ BY THIS PE IT STARTE WI7HIN <br /> cvcrctt PUBLICWORKSDEPAPTMENT 7g0 D�YS OF DATE PERMIT IS ISSUED A HEREAFTER IS TO <br /> � 3200CedarStreet BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY B[ <br /> Everett,WA 98201 CANCELLED BY THE CI7Y UPON ANY STOPPFGE OF WORK ON THIS <br /> Phone:259�BB10 pROJECT O'.'ER 90 DAYS DURATION. <br />