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i <br /> � <br /> �I <br /> � <br /> � e J � publlc WOMs Petmlt a ��1710 � <br /> oate��5 �'�� POSTING BIEqDept��{GSQS� <br /> qppliwtion For _,� j <br /> WORKS P RMIT Pu0licWorkefee s <br /> Totel Fee <br /> PUBLIC <br /> � Le��AVG�Fea Peid S—�— <br /> U 2f� <br /> Belance Oue S �' <br /> �' oon �+ •-� <br /> Print or Type Only �_ ": "' `'� °� `�� <br /> � n .r u.i ,o � <br /> . .� bM1 f �I �O <br />' p�� ..� �p. ..� <br /> .y- y� v� IR <br /> Brock Babbich 10929 Evergreen W� Bl� G Everett 98204 5 Z3P 21G5 phone <br /> Owner MaJmg Address m � � � ;i Q��Yw <br /> �,i a c, ��,: � . � <br /> T.+ O C� (_i rr ^' 4! <br />�,f .. Ciry ZiP Phone <br />'S� Applicant Mailing Address <br />� addition �— <br /> Describe ProPosed Work <br />�ry � W <br />��` , ���,.��; � <br /> prolect Address(if known) 10929 Ever reen Wa Bld G <br />� �� <br /> � � � � Attach tour(4)copies ot Plans for proposed work-Draw to scale and note�Ceniterline of tPeei`able: � <br />� �� ' . � • Property Lines � Indicale North <br /> q� • Outline and dimensions of a�l ezisting and � Show any proposed greding changes <br />�, � � � proposed structures on the lot � Show measurements M �`, ; <br /> .�� , � • Existing and proposed utilities W , <br />� � ' DO NOT WRITE BELOW THIS LINE O � ' <br /> i '� � '� <br /> �a- � PERMIT CONDITIONS � � <br /> 1,pll cells for Inspectbn shall be mede 24 hrs.in edvance-phone 25&8810• ry <br /> � p,p��work shall be performed in eccordance with this permil and curtent City of Everett Design and Construction ..,,{ <br /> StendardsandSpecificationa � _,`�.�i <br /> 3.Call Locet�on Underground Service 48 hre.betore you dig.TOLL FREE NUMBER 1•800'4245555. <br /> �D P�J�I b� GIo. O �,' <br /> � ��y��,� � y�� � d�M t��� <br /> �wtu�l ar °:4� <br /> � �� <br /> 0 ' <br /> a <br /> ACKNOWLEDGEMENT Of CUNDITIONS <br /> The undersigned owner/applicant hereby agrees to hold and save harm• � <br /> — less lhe Ciry of Everett irom any and all claims for damages, costs, � <br /> �� expenses, or causes ot action that may arise beceuse ot installation <br /> and maintenance of the improvement or other right•of-way use hereto <br /> � � applied for and turther agrees to remove same upon notica from the <br /> Approv I on ction �- <br /> Dale City and to replace public property damaged thereby. <br /> a� �7 — S � � C � �—�Z'�/'r <br /> Date Date <br /> F AL INSPECTI N Signature ot APP��canl <br /> ApDroved as Co�islructed y�/pRK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> PUBLIC WGRKS DEPARTMENT BE DI�LIGENTLY�PURSUED TO'COMPLETI()ND H SEPERMIT MAY E <br /> 3200 Cedar Street <br /> Everelt lVA 98201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone:259•8810 PROJECT OVEF 90 DAYS DURATION. <br />