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��_,..�� _ <br /> _;. -------_- -- - - - - ---- ---- —— --— - — <br /> .., . . . . <br /> � ,r � � (,J �� Z1 �• � � <br /> t z �, � <br /> I e V_'~_9�' � . . . � • � PubhcWorksPermil. � ��1 <br /> I ApplicationFor`� Tn �pS�I eio �eo�.i 446Fi7 ' � <br /> PUBLIC WORKS�ERMITNG_f� '� ���'� <br /> j...• Pu�l¢WorksPee <br /> T. Toial Fee $_ <br /> G <br /> � „ �ess AOPI Fee Paie 5 . <br /> Print orType Oi ly :G '^�' � � � �'+' � � � � � eaia ceDue S [. ��� <br /> a vi r. 00V, o ao 000 <br /> fJ � �t h M � M b� 4 � �� , '. <br /> � ��� � `V �t , <br /> M. �. <br /> Alfre� ,Iubic 1321 19th 7z i�ukl�Ceo�82?5 290-14�b � <br /> Owner Maifing AA ss � � � ', <br /> �.i � `i.�i � � :ii '� C�t ~ 4 �il �i r�Z�P Phona . <br /> � t� � �i � n3 [� w <br /> (hanei � .- C.� � ai� � :� 'ni m �n x�s ui -". i� ,� <br /> Applicant Maihng Atldress -• Clty Zi <br /> P Phone <br /> Describe Proposed Work �1�=w hollse <br /> r,oe i oc �r izoz-s�-ys <br /> Project Address(if known) ����F' L7�L�I'� \VO(�'� F-iV � �� <br /> Attach lour(4) copies ol plans for proposeA worh� Dn•••to scale antl note ihe tollowing as apUlicable: � �� <br /> • Property Lines .---� ! • Centerline ot streel � , <br /> • Outline and dimensions of all ezisting and n Indicale Noith <br /> proposed structures on the lot . • Show any proposed grading changes I <br /> • Existing and proposed �dillties • Show me.�surements � <br /> ' DO NOT WRITE BEIOW THIS LINE O <br /> PERMITCONDITIONS - <br /> 1.All calls for inspectionShall be made 24 hrs.in advance•phone 259•8810. � , <br /> 2.All work shail be performed in accordance with this pen^it and current City of Everett Design and Construction <br /> Standards and Specificetions. . <br /> 3.Call Locbtion Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1-800•424•5555. � � <br /> r <br /> O <br /> . � <br /> Y/ <br /> . O ; <br /> � � a <br /> �- 1�1�' ACKNOWLEDGE-MENT OF CONDITIONS � <br /> �) <br /> The undersigned owner/applicant hereby agrees to hold and save harm� , <br /> � Iqss, Ihe Gty ol Everett Irom any and all ctaims for dama�es. costs ' <br /> ,� /� / �/ expenses. or cacses ol action that ma arise because ol installation <br /> � ; �.c-Q `/ (_ /n Z yI and mamtenance of lhe improvement or other right�ol-way use herelo � <br /> �� � apphed lor and fw'her a�rees t0 remove Same upon notice Irom the <br /> Approved for Construction / ., Date City and to repl.ce p�blic property d� ed t ereby. � <br /> ��.�C. � . �. 1 % ,J�" � � i <br /> FINAL INSPECTION Date ' \ %X '�` �� <br /> Approved as Constructed Siq ature Applican! Dat . <br /> �A�� PUBIIC':VORKSDEPARTMENT WORK HORIZED FY THIS PE IT MUST BE STARTED WITHW .. <br /> 3200CedarStreet 180 DA S OF DA7E PERMIT IS I SUED AND THEREAF7ER IS TO <br /> Evereti,WA98207 BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Phone:259�8870 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WOFK ON THIS <br /> PRO.IECT OVER 30 DAYS UURATION. <br /> � . _. . . _ . _ . . _ . _ ._ . . . . _ . . . . _.. . . _�_ . .._ �. <br />