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_� <br /> � <br /> Date�1(�_85 PuELc Wo�ks Pe�mi�/♦�855���!--�39 <br /> Bltlg.Oept• �s �� � ' � J� <br /> , Application For <br /> PUBLIC WORK� PERMIT PubliCWarksFae — <br /> Tulal Fee s— <br /> LoSs ApO�Fea Pald $ �' � <br /> Belanco Due S <br /> Print or Type Only <br /> Village Properties 16303 �'1wY 99 , Suite 1 -B, Lynnwood , WA. 9F�37 745-3100 <br /> Owner Mailmg Address City .':p Phone <br /> z <br /> Villaee Pioaerties 16�0� Hwv 99 Suite 1 -B Lvnnwood WA 98047 745-3100 � <br /> Appllca�t MailingAddre�s City Zip Phone ti <br /> m <br /> Describe Proposed Work j i <br /> .. --� <br /> N S <br /> m <br /> v <br /> W = � <br /> m � <br /> Project Address(if known) <br /> 4705 Glenwood Aven�ie Everett. WA 820 � � m <br /> Attach four(4) copies of plans for proposed work• Draw to scale and nole lhe lollowing as applicable: � m � <br /> � Property Lines • Centerline of street � Q = <br /> • Outline and dimensions of al!existing and • Indicate North <br /> proposed struclures on lhe lot • Show any proposed grading changes � _ <br /> �� Ezisting and proposed utilities • Show measurements M - in <br /> W ` <br /> � <br /> � DC NOT WRITE BEI.OW THIS LINE <br /> � -n n <br /> PERMIT CONpIT�ONS � m <br /> x <br /> 1. All calls for inspection sliall be made 24 hrs. in advance- F`�one 259•881 5. m `� <br /> 2. All work shall be performed in accordance with this permit and current City of Everelt Design and Construction � oo � <br /> Standerds and Specifications. r' �^ <br /> 3. Cali Location Underground Service 48 hrs. before you dig.TOLL FREE NUM6ER 1-BOO-424•5555. � � �^ <br /> 3 tn <br /> m <br /> 7`„ Ass'�►'e�� �,eirF�day .S.s�a�G .e�F f��✓sr.eac�GD oF� O �m <br /> T e� E,asr SiO�' Of T//E crr4•��d bE -' (,LI,L'd�� � <br /> L�lSG.�S SHQ['L FACE EAS%i � z <br /> � � <br /> x <br /> � N <br /> z <br /> 0 <br /> a � <br /> � <br /> m <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees to hold and save harm• <br /> — less ihe City of Everett from any and all claims tor damages, costs, <br /> expenses, or causes of ection that may arise because of installation <br /> � / ,��_ � ?� t�s- and maintenance of lhe improvemeM or other righbol-way use hereto <br /> „/�c� fJ' v applied for and Wrther agrees to remove same upon notice from the <br /> Approved for C structlon � Date Ciry and lo replace public properry damaged Ihereby. <br /> �� � �� ���-�1 ��%' ( �/�' — S–/���– <br /> '�INAC INSPECTION �a�e �� Date <br /> Approved as Construcled ignature o pplicant <br /> WORK NUTHORIZED BY THIS PEFMIT MUST BE STARTED WITHIN <br /> everett PUBLIC WORKS UEf'ARTMENT 180 DAYS OF DA7E PERMIT IS ISSUED AN6 THEREAFTER IS TO <br /> � 3200 Cedar Sireet BE DILIGENTLY PUFSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Everett,V!A 98201 i CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone: 259•8815 pROJECT OVER 90 DAYS DURATION. <br />