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�- � <br /> D�te�85 PUEIicWorksPei�nit� �� /�� <br /> BIOp.Dept R <br /> Application For <br /> PUBLIC WORKS PERMIT P°°To,eFa;F°a S <br /> Less AOP�Fee Paltl S <br /> Baiancao�e S -^��i�7L� <br /> Print or Type Only <br /> Uilla�e Properti �a 15�03 Hwv 99 Su� te 1@, [ ynnwood,, Wll 480 �7 74F_�1nn <br /> Owner Mailing Address City Zip Phone <br /> z <br /> Villar�e Prooerties 16�Q3�y qq , ���� r.P 'I�, 1 ynn��nnri r�+jQ QRC1�7 :4�-�inn � <br /> Applicant Ma�l�ng Address :iry Zip Phane m <br /> Descdbe Proposed Work Si n�l a FamjLjL.EP ' ''Pnna ,. ... <br /> -� �t <br /> ... .-� <br /> N S <br /> m <br /> . W � <br /> � o <br /> m� <br /> Pro�ectAddress(ifk�own) _ 4�1� G] ettWOOd Avenue. Everett. WA 98203 � � m <br /> -�z <br /> Atlach fow(4)copies of plans for propos^d work• Draw to scale and note lhe iollowing as applicable: � _� <br /> � m <br /> • Property Lines • Centerline of street p = <br /> • Outline and dimensions ot all existing and • Indicate North � <br /> proposed structures o�� ine lot • Show any proposed grading changes � _ <br /> � Existing and propose�i uti�ities • Show measurements M � y <br /> W � <br /> �, <br /> DO NOT WRITE BELOW THIS LINE O o A <br /> P[RMIT CONDITIONS � � <br /> x <br /> 1. All calls for inspection shall be made 2A hrs.in advance- phone 259•881 5. � m N <br /> 2. All work shall be performed in accordance with this permit and current City ot Eveiett Oesign and Constr,.^ticn p <br /> Standards and Specifications o r <br /> 3. Cell Localion Underground Service 48 hrs. belore you dig.TOLL FREE NUMBER 1•800-424-5555. � 3 N <br /> z c'� <br /> O —i r <br /> m <br /> n <br /> p <br /> � � <br /> 2 <br /> a <br /> z <br /> � � <br /> � <br /> O N <br /> z <br /> 0 <br /> a � <br /> � <br /> m <br /> -.� <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned ownedapplicant hereby agrees to hold and save ha�� <br /> Iess the Cily of Everett from any and all claims lor damages,�coe. <br /> expenses, or causes of action thal may arise because of inslallat'r� <br /> „(���� ��✓ ���/ �� and maiNenance ot the improvement ur other right-of-way use hereto <br /> y) applied for and further agrees to remove same upon notice from tho <br /> Approved lor C struction Date City and to replace public properry damaged thereby. <br /> / �� � � /�"-/3- f r �,�� S-l..S=9,y- <br /> FINAL INSPE TIO� �a1e Dale <br /> Approved as�onsVucted Sig;iature of Applicanl <br /> WORK AUTHORIZED EY THIS PERMIT MUST BE STARTED WITHIN <br /> everett PUBLIC WORKS DEPARTMENT 1P0 DAYS OF DATE FERMIT IS ISSUED AND THEREAFTER I.� TO <br /> � 3200 Cedar Street BE UILIGE� LY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Everett,WA 98201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone: 259�8815 pROJECT OVER 90 DAYS DURhTION. <br />