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- <br /> Application Fa Date��2� � e <br /> �i�� PUBUC WORKS PERMIT <br /> PUBLIC WORKS DEPARTMENT .0 Public Nbrks Pertnit k ____��D�& � <br /> 3200 Cedar Street ;)1 <br /> Everett,WA 98201 259-8810 �' Building Permit M_ <br /> f,l <br /> TYPE OR PRINT ONLY pumb works Fee t '�O=_ . 6'` <br /> � ' ' � �1A'2D 1� .w '��'ae� <br /> l' av"� l�t _r�A��F�. ��i-L� c'��r�,�r4sc ��Ee.�Y w a, �uzs�33�'-� -�-(� <br /> Owner Melling Address ,City Zip phona <br /> , <br /> i i <br /> Applicanl Meiling Address i :�: �? Clty Zip Phone <br /> � , <br /> Describe Proposed Work�'T.V.I�t� =V 4� ��e� �h1(,t� PRDVr1�i 'Tia E��.�- T 1� 0� <br /> (iQDP' �21TL , . 'jliF i �/CG WD �'Lp L10 1{LOY��ti "N 'r �� I L� S t1f AJ�`+ L l�kC,E � <br /> 'cA T�.1.'4 Cp�261�1Z 1w1�TcQ D .a a T A't!( � � ' P � <br /> � „�' � � r�'CL7 Cn�1�� 7� o� �ON S:IC NOU:.L• Ac 5 E STZ.c � ! ZC�1 � <br /> W0� t. � � � _. � -' . ..�� . ;, V/ <br /> PROJECT ADDRESS(if known) '1� l 61?vTf�f ' �'( " i ' '1 ^' � �`a �' �, ^ � <br /> Attach four(4)coples ol plans for pro�esed w•ork-Draw to scale end nola the following II epplicable: O . <br /> 'Property Llnas 'Outline end dimenslons ol ell axisting and proposed at�uctures on ihe lot �Exlatlnp and proposed utilities <br /> •Cente/line at siraet 9ndlcate North •Show any proposed grading chenpes 'Show measuramenta � <br /> DO NOT WRITE BELOW TfiIS LINE <br /> PERMIT CONDITIONS: 2 <br /> 1. All calls for inspectlon shall be made 24 hours in advance- phone 259-8810. O <br /> 2. All work shall be performed in accordence with thls permit and cu�rent City of Fverett Design and <br /> Construction Standards and Speciflcations. <br /> 3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800-424-6556. � <br /> � /�'L4�(�r�wr-� , � <br /> Nciy�C/� o{' �e�u c.�,��,,:. �h� O <br /> �,5�- �f w�y s�4 « eE qz „ <br /> - a <br /> �D��e 4S S'�own Qh ���r<d ,�aH, <br /> �G� <br /> �' <br /> ACKNOWLEDOEMEN7 OF CONDITIONS <br /> J The undarsigned ownor/epplicant hereby egrees to hold end eava hertnbsa <br /> _1 _��� � o� , �� Ihe Gly of Evereu Irom eny end all clalms lo�denages,costs,expensas,or <br /> FAP� ved�or o ruction e cauaes of ectlon Ihat may erisa because o1 Instellation and meintenance of <br /> � j� / thelmprovemontorotherright-ol-weyuseheratoepplfedlaendluAheraprees <br /> ,�/ / � to remove 4nme upon notice Imm the CBy and to replece publlc pmparty <br /> /���/ �v 8 � damege�'thcraby. <br /> FINAL INSPECTION Date / <br /> .4pproved as Constructed �e� �/� �1��� /,r al;/Gf y <br /> Signatura ol App��tf d Deta <br /> WORK AUTHORIZED BY THIS PERMIT MUST BE STARTE�WITHIN 180 DAYS OF DATE PEHMR IS ISSUED AND 1HEHEAFiER IS TO BE DILIOENiLY PURSUED TO <br /> COMPLETION.THIS PERMIT MAY BE CANCELLED BY THE CITY UPON ANV STOPPA6E OF WORK ON THIS PRWECT OVER 90 DAYS WRATION. <br />