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� -_. . �.....'-. �r,.... .•'�?k� . ?r�,..: '6�7.'QE�X:,�'Jrn'T.. .n2��n�"^ . . . , '._' . -- . . .--�—.�9c--•,� V4�«'n <br /> -: ..„.-... ._. _ . .' � <br /> .. w- .._._.. �.. _.... .-„ .�.-.. . <br /> � ;� �"'&5ys'i 'F.,« <br /> 5--19�-9A� � �J�- .��C=�'��I- 1�g l_ <br /> Date— � PuDlic Worb Permlt• ��4/t <br /> � Application For eiao.oso�.• 4 344 5 <br /> PUBLIC WORKS PERMI .°°°:o„FaeFee s <br /> TO POSTING �eeenpplFeaPeie s <br /> JUN 1 2 lggg o�a a z,v— <br /> Print or Type Only ��r S g $ g ,R $ <br /> � �Oa �� � �i � p(� p�]yin <br /> - • � N M N �O �GN <br /> DARCY HAISLEY 4521 FORE3T DR E��F.F.ETT 98203 . 9-5907. "' � � � w <br /> Owner Mai4ing Address �Ci i Phone � <br /> 04TidEK � � 5 � � � � �i � � � � <br /> Applicant Mailing Address � Crty Zip Phone <br /> Describe Proposed Work 11� HOUSE <br /> Project Address(if known) '�'7 �5 fo r~e�'� ��"�V(�i ' � <br /> Attach four(4)copies of plans for proposed work• Drew to scale and note the following as applicable: � <br /> • Property Lines • Centerline of street � <br /> � • Outline and dimensio�s of all existing 2nd • Indicate N�rth <br /> proposed structures or�the lot • �how any proposed grading changes <br /> • Existing and proposed utilities • Show measurements . � <br /> DO NOT WRITE BCLOW TFIIS LINE <br /> PERMIT CONDITIONS O <br /> 1.All calls tor inspection shell be made 24 hrs.in advance•phnne 258•8810. � <br /> 2.All work shall be perfarmed in accordance with this permit and current City of Everett Destgn and Construction <br /> Standerds and Spectficationa <br /> 3.Call Lxation Underground Service 48 hrs.before you tlig.TOLL FREE NUMBER 1•$00-424•5555. � <br /> � O <br /> ' � <br /> � <br /> " �� � <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owneU,pplicant hernhy agrees to hold and save harm- <br /> �ess the City of Fverett from any"an`d �all claims for damages, costs, <br /> expenses, or causes of action Ihat may arise because of installation <br /> 6 ,J— g nd maintenance of lhe improvement or other righhof•way use hereto <br /> � applied for and further agrees to remove same upon notice from the <br /> Approved r Constr io ate <br /> � � City and to replace public property damaged thereby. <br /> �„ " " �'/r•L+I I � . <br /> FINAL INSPECTION Date <br /> Approved as Constructed Si9nature oi A icant Date <br /> PUBLICWORKSDEPARTMENT WORK AUTHORIZED BY THIS PERMIT UST BE STARTED WITHIN <br /> 3200CederStreet 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everetl,WA 98201 BE DILIGENTLY PURSUED TO COMPLETION.THIS PERMIT MAY BE <br /> Phone:259-8810 CANCELLED BY THE CITY UPON ANY STOPPAGE OF ItiORK ON.THIS <br /> PFOJECT OVER 90 DAYS DURATION. <br />