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Q_��^ i� Publ¢Wo�ksPermn• - <br /> Date� U PiO� OeO� • <br /> Appliwtion For <br /> c�m�c Yrorks Fee 5 ZG.j U� <br /> pUBLIC WORKS PERMIT T�,��FeC <br /> Less Aoo��Fre Va�e $�—�--- <br /> BalznceOuc $ �O J <br /> Print or lype Only <br /> �n�11 � l.�?R�.Sm-� �Ill'J � � I1�UE Q,��i<<-i�bh ��bz�3 -- 3��38a <br /> Owner Madmg Address �'�1' <br /> 2iP Phone <br /> 5/S//C � GitY 7_ip --Phone <br /> �ppGcant Mailmg Adaress <br /> E@ 1� C�e t-.�i��—�- � lz �t'i...c'v�� C�C a v�i- (� <br /> Describe Proposed Work <br /> � <br /> 1/ ��I �'Y� V �{ �� C 5 I �L�t.-7=�u� t U li��A H � <br /> _^ ///� --Qj " _ H-7 D C�J _ W <br /> — � F-'1 t, � <br /> cJ � •— -� L- - / <br /> P�olect Aadress pf known) �- , - <br /> � <br /> Atlach four 14) cop�es ol pians tor propo5ed work- Dra�• to scale and note Ihe lollo�ving as apPlicable: � <br /> • Property Lines • CenterGne of street <br /> • Indicate North <br /> • Outline and dimensions ol all existing �nd � Show any proposeC grading charges <br /> proposed structures on the lot � ghow measurer.ients M <br /> • Exislin9 and proposed utilifies W <br /> DO 'J0T�7FITE BELOW THIS t.INE � <br /> PERMII'CONDITIONS � <br /> 1.All calls for inspection sl��all be madc 24 hrs.in advance•phone 2��9•881 Q. <br /> 2.All work shall be performed in accordance with this permit and current Ciry ot Everelt Design and Construction <br /> Standaids and�pecifications. � <br /> 3.Call Location Underground Service 48 Ivs.before you dig.TOLL FREE NUMB-A 1-800•424•5555. <br /> • <br /> C�T/7�%�-� .�'f` C��/�`C.�c``_— O <br /> � �=:��J' /�� � - �-� <br /> `>� � _��;.5,;�--�;����' . I'�' <br /> � <br /> � <br /> a <br /> ,aCKNO�NLEDGEMC-NT OF CONDITIONS <br /> The undersipned owner/apGlicant hc�eby agrees to hold and save harm� <br /> / � �%� Iess Ihe C'�y ol Everett irom any and all -laims for damages, costs. <br /> �.�, �� � // �- � eapenses. or causes of action li�.at may arise because ol installation <br /> �'�� / a d mainlenance ol the improvemenl or olner righbol-�vay use hereto <br /> �Cf`� _�� pplie and furiher agrees lo remove same upon nolice irom the <br /> � �o or Construc io ' Date City nd , eplace ubhc property damaged thereby. <br /> =� � �------ . ��--- ��g�� <br /> �% <br /> FINAL INSPECTION Date � - Date <br /> Igna�u � f Applicant <br /> ApUroved as Gonslructed <br /> WORK A THORIZED 8Y THIS PERMIT MUST BE STARTED WIT <br /> i,�i,��,�� pUBIICWORKSDEPARTMENT 180 DA S OF �ATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200CedarSlree� BE DILIGENTLY PURSUED TO COMPLETION. THIS PEFMIT MAY BE <br /> Evcrett,WA 96201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone:253�8E�10 PROJ[CT OVER 90 DAVS DURATION. <br />