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`�' /-� .o <br />Date �-i''9' � -' I ��,����,o,.zPe,m,�. � � <br />Appiication For <br />PUBLIC WORKS <br />Print or Type Only <br />Shepardcon Robert/Carelyn 4024 <br />Ownei <br />Applicant rAailing <br />c. <br />�ERMIT <br />J <br />� <br />� � o o ti <br />�Y .t p N <br />Ll M ' <br />1� rl �. <br />ri,�a Ceoi.+ <br />P�o�¢ WarFs Fee <br />iatal iee S _ <br />Less AOPI Fqe Paia S <br />e.,��. .�. r„�.. 5 %�i� � <br />Ave Everett 98201 258-SOSG <br />sLs � -�- wry Gp <br />r�l � �J (U�, - 4�'. <br />N 6? i^ � U <br />0 <br />� <br />� <br />Phcnn <br />oescribe Proposed work chunge of uee to add retnil epace to SFR, ndd handicn�ped rau�p 6 porch <br />Proiect Address hf knownl <br />A�taeh four (4) copies of plans lor proposed work � D�av: to ;r,ale .�nA nete the tdlowin9 as apUlicable. <br />O Property Lines • Centerline of streel <br />• Outline and dimensions ol all ex�sting and • Intlicate North <br />proposed siructures on the lot • Show any pronosed yrad�ng chanyes <br />• Existing and nroposed utilities • Show measuremenis <br />PERMIT CONDITIONS <br />1. All calls for inspection shall be made 24 hrs. in advance- phone 259-8810. <br />2. All .vork shall be peAormed in accordance with this permit and current City ot E�erett Design and ConsVuction <br />Standards and Specifications. <br />3. Call Location Underground Service 48 hrs. be(ore you dig. TOLL FREE NUMBER 1-800•424•5555. <br />�{. � ��,ic� ; iC'�,�/ J�v��- ��nf Co �_1���,n %0 �-� llC��. <br />�. �a�����;� �-=Z/�r �1�":'nI�CF1 _�r,.� ���wtv� 'c -��,«�. <br />I <br />�C ` � % / I �"iLr � ✓ � �S i <br />Approved for Construction � �� Date , <br />FINAL INSPECTION <br />Approved as ConctruCted <br />� PUBLIC WOFKS DEPARTMENT <br />3200 Cedar Street <br />��Tr Everett. WA 98201 <br />Phone:259-�810 <br />�o <br />W <br />H <br />� / <br />• <br />��A <br />V♦ <br />O <br />a <br />ACKNOWLEDG[MENT OF CONDITIONS <br />7�v undrrsaned owner/applicaM hereby agrees to hold and save harm� <br />tess thc Gty ot Ecerett Irom any and all claim; tor dama9es. cosis <br />expenses. or causes of action that may arise because ol inslallation <br />and maintenance ol the Improvement or other righ4ol-way use hereto <br />ypphrd Ipr and luf�her agrees to remove samr. upon no�ice frQi» �he <br />CRy antl to replace Pubhc property damaged thereby. <br />�,�, <br />/� � � � �/^ � !� � //j ���. �'I�-..i//�..-. <br />$Ignature ol A phcant Date <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STAFTED WITHIN <br />lA0 DAYS OF DATE PEFMIT IS I�SUED AND THEREAFTER IS TO <br />BE DILIGENTLV PURSUED TO COPAPLETION. THIS PERMIT PdAY BF <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PFOJECT OVFR 90 DAVS DURATION. <br />