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r <br /> �1 <br /> . � <br /> Date 7 �7 �� PuElic Work�Parmit� �� /�� <br /> � BIOq.DeO�.• <br /> Application For <br /> PUBLIC WORKS PERMIT °°°To,:°aaFee ��—�-- <br /> � Less�VGI Fea P�IA S r 7 <br /> r--�� �� <br /> B�bnoe Dua S S— <br /> Print or Type Only R� (03/�.�� <br /> MV V��av.�...v �V/G /v /`6tk �Yiu. Ewv+� ZJ � ��/d <br /> Owner � Meiling Address City Zip Phone <br /> SwdJ,\e.Ws o...a� pv// /�cw;f�- 9�� �/ 33�1 %�Yl <br /> Applicant Mailing Address City Zip Phone <br /> Deacribe Proposed Work �� s�lta"� `'� ��'"e � d� <br /> sCw.. C'I�y. 4��'�� <br /> W <br /> Prolect Address(if known) w� � <br /> Attach four(4)copiea ol plens for proposed work• Dra�v to scale and note the followinp as applicable: � <br /> • Praperty Lines • Centerline of street � <br /> • Outline and dimenslons of ell existing end • Indicete North <br /> proposed structures on the lot � Show any proposed grading changea <br /> • Exlsting and proposed utilitiea • Show meesurements M <br /> W <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 1. All calls tor inapectlon ahall be made 24 hra in advance•phone 259•8815. � <br /> 2. All work shall be pertormed In accordence with lhis permit and current City ot Everett Design and Conatructlon <br /> Stenderdn and Speclflcationa <br /> 3. Cell Location Underground Service 4B hrs.before you dig.TOLL FREE NUMBER 7•800�424•5555. � <br /> � '�a��ww��� � QG.+..�..� 5��1\ N�. Saw �G.ti� � O <br /> Clv...+s1/�� � Y.t�e.rls� Gta �wy►s.�:� ;o�..� <br /> � • '1�Cww`til `r'1lJ�t �^"w1� �t �v���sl�l�Y �r��r H <br /> \ � <br /> .� �r..f- h..�1� � <br /> G . 11N� ,45,.., � �C ,,�..,ti . �..,,,v.., .L-(� � ��� 0 � � <br /> dc� s,�e,,..a�k �- .�tt �-.,^.:� r , <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/appllcent hereby aproee to hold�nd seve harm- <br /> leas the Gty ot Everetl Irom any and all clelms for d�m�pea, coat& <br /> expenaes, or ceuaes ot ectlon thet may eriee bec�ute ot Instelletlon <br /> �,7��} end meintenance at the improvement or olher riphbof•w�y use hereto <br /> appiled for end further egrees lo remove eame upon notica from the <br /> A oved for Constructlon Date City end to repleca public propeAY demaqed thareby. <br /> � � 1/6c��J y�r— 7�?� J <br /> F AL INSPECTION Date \ "� � Date <br /> Approved as Conatructed Signe ure ot ApPlicent <br /> WORK AUTHOFiIZED BY THIS PERMIT MUST BE STARTED WITHIP� <br /> e�� PUBLIC WORK3 DEPARTMENT 1B0 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200 Ceder Street BE DILIGENTLV PURSUED TO COMPLETION.TMIS PERMIT MAV BE <br /> Everelt,WA 88201 CANCELLED BY THE CITY UPON ANY STOPPA6E OF WORK ON THIS <br /> Phone: 259•8815 PROJECT OVER 90 DAYS DURATION. , <br /> t. � <br />