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i <br /> �� <br /> Date.��Ez� ��m c ao�w�vermii a�• _�•� <br /> B'.q Deo� • <br /> Appllcotion For <br /> PUBLI(: WORKS PERMIT PueTnteFee"� _ <br /> leu�DV�.Fee Pud B <br /> a0 00 <br /> B�I�ncc Due B <br /> Print or Type Only <br /> �_ � �� 7� �7 S�� ��r-t7 «'t�`7� �.s��� <br /> d�,r o .. <br /> Owner Melling Atld�ess City Zip Phone <br /> ~pPPl�ca�,� Melling Adtlre53 l iry 2ip PhOne <br /> Descrlbe Propoaed Wo�k ��Q�� `��.� <br /> - W <br /> Prolect Atldreee(il known) ���� � C�EsTi(�L�� � <br /> Attech lour(4)eopiee ol plans for propnaed work• Draw io scele and nole fhe lollowing as epplicahle: � <br /> • Property Llnes • Centerline ol street � <br /> . • Oulline and dimenslons ol all existing ond • ��dicate North <br /> propoeed atructurea on Iha lot • Sh�::a�;�roposed giading changos <br /> • ExletlnB and proposoA ulllities • Show measurements � <br /> DO NOT VlRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 1. All calle for inepecllon shell be meda 24 hrs In edvence•phone 259•881 5. � <br /> 2. All work ahall be peAo�med in accordance with this perm�l end cunent City ol Everetl Design and Construclion <br /> Slendards end Specilicetiona <br /> � 3. Cell LoceNon UnAnrg�ound Servicn 48 hre. belore you dig.TOLI.FREE NUMBER �•B00•424•5555� � <br /> O <br /> � <br /> � <br /> O <br /> a <br /> ���� <br /> AGKNOWLEDGEMtNT OF CONDITIONS <br /> The undersigned owner/npplicanl hareby agrees lo hold end snve harm• <br /> Iass the Cily of Everett Irom any and all cleims lor clemages, cost4 <br /> ���� / azpenses, or causes ol action Ihat may erise baceuse ol inetelletion <br /> .r'�1 g� and ma� �he imp�ovemanl or other rlght•ol-way use hereto <br /> � �Approved for Constr ction `� � Dale P� d lor and furth agrees to remove aeme upon nollce Irom the <br /> C' end to replece publ property demeged Ihereby. <br /> +nl'T<C���� 9•l�'i-FL , �,,., <br /> �� <br /> F I PECTION Dale — <br /> Approved as Constniclad Signelure of Applicant a�� <br /> PUBIIC WORKS DEPARTMENT WORK AUTHOR�ZED BY THIS PERMIT M115T B[ STARTED WITHIN <br /> everett 180 DAVS OF DATE PERMIT I: ISSUED AND THEREAFTER IS TO <br /> � 3200 Ceder Slreet BE DILIGENTLV PVFSUED TO COMPLETION.THIS PERMIT MAY BE , <br /> Everett,WA 98201 CANCELLED BV THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone:259-8815 PpOJECT OVER 90 DAYS DURATION. <br />