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1 <br /> � <br /> Y <br /> � � � <br /> Q �� � � <br /> � �� q '"` '�� ,,�, �. ,m� [(�� <br /> Defe� n,e .i=� i.�-1 C� <br /> Application For ��"0 �"o� • <br /> � �� PUBLIC WARKS PERMIT °°°°�w�,�,���-------- -- <br /> y �+ � .o�.�... s <br /> � O� lma nnni ren Pue f_ �� <br /> � H e.ia�«rn,. 5 <br /> n� Print or Type Only � , <br /> L�J <br /> � H� � <br /> � y �"�-- <br /> M Owner Mailmg AAdress Ctly Zip Phone <br /> OyM <br /> ��N <br /> � Appl¢nn� Maihng AAdress Cily 7ip phone <br /> O I' /^�� I/+ <br /> y Describe Pwpuaed Wnrk ._ �,(�� (�L[ �L �. __ <br /> Pwlecl Address Id known) �� � • a �� [J�/ ��f�.. � <br /> � <br /> Atlach four�4)copies �I plans lor proposP.d woik� Draw�o s[nl��nA note Ihe folbwing as apphcable. � <br /> • Property Lmes • Cenlerline ol slreel � . <br /> •llutlme and dimens��ons ol ell o��sling and • Indlcate North � <br /> proposetl slru[tures on Ihe lot • Show pny propusetl prad�nq changes <br /> • [x�sting und piopoSeC u1161ie5 • Show measuremenls � <br /> DO NOT WRI7E BELOW THIS LINE O �� <br /> � '�t PEfiMITCONDITIONS <br /> 1.All calls lor Inspection shell b�maue 24 hrs.in adv�nce�phone 259•8810 � <br /> 2 All wark ehall be podormed In ec[ordente wilh Ihis peimil end currenl Cily ol Everel�Design end Consiru;tion <br /> '�1 Stenderds anr'Specilicetlons. <br /> 3.Call Location Untlar�round Service 4B hrs.belore you dip.TOLL FAEE NUMBER 1•800•424•555$. <br /> k - ' <br /> x 1_I 11�� ��C� . �;l � <br /> I"1 �� <br /> �_� yaa-sg � <br /> _� V� <br /> �- O <br /> _� a <br /> � <br /> � ACKNOWLL'DGEMENT OF CONDIilONS <br /> ' The unders�gned ownai/appl¢nnt hereby a9rees to hold antl save harm- <br /> ' — less Ihe Cily ol Everett Irom ,ny anA all claims lor damnqes, costs. <br /> e�penses. or causes ol nclion Ihal may arise Uecnuse ol r StqL'etion <br /> nnd maiNenanr,e ol I�e improvement or other nghl�ol-way vt hereto <br /> a{;phpA Inr enA �ur�her agrecs lo remOve Same upon notice �mm �he . <br /> pnnroved lor Conslruction Oxle Ctly anA lo rrnL�ce public nropmly damaged Ihereby � <br /> FlNAL INSPEC110N Dale _ _ <br /> Approved as Consirucletl Sicl�alure ol Applir,anl Dnte <br /> rorrrll PUBLICWORNSDEPAf1TMENT H'DRY, AUTHOR12ED BY THIS PEfiMIT MUST �E STAqTED WITHIN <br /> O J200CederStreel 780 DAYS ��F DATF PERMIT IS ISSUED ANO THER[AFTEF IS TO <br /> [veretl.WA98201 BE DILIGENTLY PURSU[D TO COMPLE710N THIS PLRMIT MAV 9E <br /> Phonc 159-9910 CANCELIfD �V THE CITV UPON ANY STOPPAG[.OF IVOPN (lN THIS <br /> PROJ(.-CT OV[R 90 DPVS DURnTiON i <br /> � <br /> – _- <br />