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� k -w-za• s �,,�9 / <br /> Da1@�_� Puobcwe�k�Per • <br /> Appllcation For Bmp oen��• <br /> PUBLIC WORKS PERMIT P�bncWorksfee — <br /> Tolel Fee Z <br /> Lee��ool iee Peia S -��.p� <br /> Print or Type Only Belnnce D�e S �"1"— <br /> L1.�i11�i11_._�'!�C�l1S �09 �� �t �'�,r�48�1 a�3-�- 3 <br /> Owner MeilmgAddress C�ty Lp Phonr, <br /> ll �1 <br /> qpplicant Mefling Atldress Cily Zip Phone <br /> Deecribe Proposed Work ����C/� � <br /> Prolect Addresa 111 known) Z�Z� A t $ G 1{� L N,�� � i . <br /> � � <br /> Altach lour(4)coplea ol plans lor nroposed work� Draw to ecale and nole the IollowinB as applicab�e: � �� �� <br /> � • Property Unea • Centerline of streot � , � <br /> � • Oullina and dimenslons of all ezisting end • Indicete Nurth . <br /> proposed etruclures on the lot • Show eny proposed grading changes ', <br /> • Exiating and prnposed utililies • Show measurements � � . <br /> DO NOT WRITE BELOW THIS LINE � <br /> PERMIT CONDITION`> O <br /> � 1.All celle lor Inapectlon ahell be mede 24 hrs.In advance•phone 259•8610. � <br /> 2.All work enell be perlormed In eccordance with Ihle permit antl currenl Clty ol Everett Deslpn and Construction <br /> � StenderdaendSpeclllcations. � <br /> 3.Cell Locallon Underpround Service 48 hre.belore you dig.TOLL FREE NUMBER 1•S00•424•5555. � <br /> O <br /> � <br /> � <br /> O <br /> a � <br /> ;. <br /> ; . . <br /> ,p ACHNOWLE�GEMENTOFCONDITIONS �I � <br /> ^�(� <br /> y The undersigned owner/epplicanl hereby agrees to hold and sava harm- <br /> less the Cily ol Everett Irom any end all claims lor dameges, cosis. , <br /> eMpenses, or causes of action thel may e�ise because of in6lallation I � <br /> � n/��✓�� I_G+�_ C]%-1 and meintenance of �he improvement or other righDol�way use herelo <br /> ���F��» �r< <' C �V applied lor and luriher agrees to remove samo upon notice Irom the <br /> Approvad lor Consiructlo Date Ciry end b replaca publlc property damxged Ihereby. � <br /> �.�'/�(CiC�_. . /V '�J—�J <br /> FINAL INSPECTION Oale ' �O � v � <br /> Approved as Conalructed Signatu ol Appl� ant �a�e � <br /> WOR AUTHORIZED BY THIS PERMIT MUST BE STARTF.D WITHIN I <br /> everett PUBUC WORKS DEPARTMENT 1B0 DAYS OF DATE PERMIT iF ICFIIED AND THEREAFTER IS TO i . <br /> � 3200CederSt�eet BE D�UGENiLV PURSUED TO COMPLETION. THIS PERMIT MAV BE I I <br /> Everett,WA 98201 CANC:ELLED BY THE CITV UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone:258�BB70 PROJECT OVER 90 DAVS DURATION. . <br /> I I <br /> � <br /> ! <br />