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/>. <br /> ��� <br /> � � <br /> H�M <br /> /iy O <br /> "+tlMht <br /> �xQ? Date 4�9�q� a�nimworxsvermua 9/�4� ._ <br /> ^� �� Application Fcr T� POSTI Nf,.._ a a� � eieg oea�.a���2t:75q ___ <br /> p�g PU�LIC WORKS PERMIT P°°°°w°��sFeP <br /> totai ree S <br /> x H� Less h00L Fee Pa10 S__ <br /> �H o <br /> �'+''3 P�int O�Type Onl�� o � o� o � c ��i eaia��eo�E S ZO� <br /> g� �� �; ��., : U o �.;� <br /> ~ r� � .-�'n� +�e*� � :n ui W n <br /> n�� � <br /> � .Y N W <br /> Dale Flinr. .-. �31 Frida Ave �i Everett 98201 � 258-9260 � <br /> y HO Wy Owner Q o � �,� za .p,3drgs� �� City Zip Phone <br /> r� oo m !�z � � 03 �w <br /> J W_.I S q W T <br /> Owner o �3i u. r r,_ a�o a m ,�,r,� <br /> Applicant Mad�,o„Adtlress Ciry � Zip Phone <br /> DescribeProposedWork NE+w cinel family racidannP <br /> W <br /> Proiect Adtlress�if known) 4807 Black Forest I,ane L <br /> r <br /> Attach four(4)copi=s of plans for proposed work-Draw tc scale and note the following as applicable: � ' <br /> • Proper�y Lines • Centedine of SVee� /^ <br /> '�' • Outline and dimensions of all ezix�ting entl • Indicate Norih V� <br /> proposed siructures on the lot • Show any proposetl qratling changes <br /> 1_' • Existing antl proposed utiliti2s • Show measuremenis � <br /> DO NOT WRITE BELOW THIS LINE <br /> ' ' PERMIT CONDI710NS � <br /> 1.All calls for inspection shall be made 24 hrs.in advance-phone 259•8810. <br /> 1�' 2.All work shall be peAormed in accordance with[his permit and current Ciry of Everett Desipn and Construciion � <br /> Standards and Specifications. <br /> '�' 3.Call�ocation Underground Service 48 hrs.before you dig.TOLL FPEE NUMBER 1•800•424i3555. � <br /> 11 O— <br /> 11 H <br /> �— � <br /> al � <br /> — <br /> �- a <br /> _�- <br /> �� ACKNOWIEDGEMENT OF CONDITIONS <br /> � The undersigned owner/applicant hereby agrees to hol7 antl save harm� <br /> � —� less ihe City of Fverett irom any and all claims for tlamages, costs. I <br /> axpenses. or causes of action that may arise because of installation i <br /> �( � il_ ���1 and maintenance o! the improvement or other righ4of-way usz herete <br /> 1�� ^� appl�ed for and turther agrees to remove same upon notice hom ihe � <br /> Approved for Constr tion Date fity and to replace oublic prope�rry dama9ed thereby. <br /> �i,l./�"-�-- �..L. <br /> FINAL INSPECTION � ��a�E -- <br /> Approved as Constructed Sigr�ature of Applicani Date <br /> WGRK AUTHORIZED BY THIS PERMI' MUST BE STARTED WITHW � <br /> evere[[ PUBUC�NOFKSDEPARTMENT 7g( pFVS OF DATE PERMIT IS ISSUED ANl THEREAFTER IS TO <br /> � 3200 CedarSireet BE DIL iGENTLV PURSUED TO COMPLETr�N. THIS PERMIT MAV BE <br /> Everett.WA 9820i �;HNCELLED BV THE GTV UPON ANV STOPPAGE OF WORK ON THIS <br /> Phone 259-8810 FROJECT OVER 9G DAKS DUF�TION <br />