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Dace y �2 � �t� ��SI��G p /� <br /> �6��3 . !� 1 � � � �l� Public Works Permlt s � <br /> � � Blag.DeGI.• 4290 <br /> Application For r <br /> r•� <br /> PUBLIC WORKSoPERMIT PUOTo1aIFeeFec � <br /> 0 p p <br /> Less ApOI Fee Paitl $_�— <br /> � o N O C�i lfl � Ci � G: r� Baiance Due <br /> $ ���-� <br /> Print or Type Only o .a ,-� ,-� ci .+ a: o o an <br /> Irl t•: r� C� J� �Y' M� M .:J ("� :r <br /> w .rt w� v� o +n w r <br /> � � .-+ w m .u''+ <br /> a <br /> Volunteers of America 2801 Broad�aa� �Ey�ere�t� �20� _ �' 9-�391 <br /> c [� o�v m b^—v�_Taat <br /> Owner Mailing Ad ss o n. z o fbt o w o w Phone <br /> +� Oh \ �+ F— O Jn�`iaor- n3 . <br /> M� n � f�i dC�] � G7 u] d � 3 � U� C=J <br /> Same Dave Matthews o <br /> Applicant Mailing Address City Zip Phone <br /> DescribeProposedwork 2 story over garage — /��p�,:�c� �fiQ�ca��eL.E . <br /> Tn �li LC rair� u � r .3'Ysfar.� 4.��✓ �c;ve Pa.-�f-,� <br /> W <br /> Proiect Address(if known) _ z SD/ — LOM/Sar d :�/�_ Lombard � <br /> Attach four(4) copies of plans tor proposed work- Draw to scale and note the tollowing as applicable: � <br /> • Pro4erty Lines • CeN�rline of street /� <br /> t Outline and dimensions of all existing and • Indica".e Nor:h V� <br /> proposed structures on the lot • Show any p�ouosed grading changes <br /> • Existing and proposed utilities • Show measu�,ements � <br /> � �� <br /> DO NOT WRITE BELJW THIS L!NE O <br /> ?ERMIT CONDITIONS <br /> 1.Aii^.alls for inspeclion shall be made 24 hrs.in advance•phone 2�9-8810. � <br /> 2.All wor{;shall be pedormed in accordance with lhis permit and current City of Everett Design and Conshuction <br /> Standards and Specifications. <br /> 3.Call Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1-500•424•5555. � <br /> �� �.IJOr� 2�o Bc C/vr� P�r pLa�� ���pf--�✓.�c� 1 O <br /> Di� ,j '/5�"yS� by f�i� �'Ve/�e�f �U6LiG �dDY.ES p�LY,rI`inE'n /. <br /> l�'nPy ¢Hu.c%arl) / �• <br /> � �t c✓c✓�� C.�co�'�'-s- �`-, �� C�� ��n. �cG�`'«E'�z o� � <br /> ' .S'kJ`�� _ C/G f�c� /%/9 S�- o <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The unde�signed owner/applicant hereby agrees to hold and save harm- <br /> less the Ciry of Everett from any and all claims (or damages, costs, <br /> L�� expenses. or causes of action that maY arise because of installalion <br /> /� and maintenance of the improvemenl or other right-ohway use hereto <br /> ` applied for and lurther agrees to remove same upon notice trom the <br /> App oved for o ruc�!oi Date City and to replace public property damaged ihereby. <br /> .�i � <br /> � �� %�'iY- 'ftj n -�yJ <br /> FINAL INSPECTION Date " — � <br /> Approved as Constructed Sign re of App icant Date <br /> WOR AUTHORIZEG BY THIS PERMIT MUST BE STARTED WITHIN <br /> PUBLICWORKSDEPARTMENT 1fi0 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> 3200CedarSireet BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Everett,WA98201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone:259•8810 PROJECT OVER 90 DAYS DURATION. <br />