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i <br /> Data ���'by Public Works Parmif_S �+� /• � <br /> a �3 a/ _ <br /> BICB.Uept�_ <br /> qpplication For <br /> PUBLIC WORKS PERMIT PubTotlFeeFee s � ,00 <br /> Less POP�-Fee Paitl S ' — <br /> Baiance Due S �•� 0 <br /> Print or Type Only �,9 J y� <br /> LaQ2� A ll.a�.�=�c iyos ���o,,� ,r� ��a1� �� 339- asg6 <br /> —p,�„� Mailing Address Ci!y 21p Phone <br /> �-Y Ceit.�ic�o,� �a�L� �tN/���� !'�'!�c EvS�T �a3 35�=.8yGs <br /> pplicant Mai�ing Addres� City Zip Phone Z <br /> 0 <br /> -a <br /> Describe Proposed Work /�F� ���"� ��r� ��P��x m <br /> .. <br /> W � " <br /> N 2 <br /> .�T ��2,oP14 E �. m <br /> Project Address(if known) c o <br /> m o <br /> Atlach four(4)copies ol plans tor proposed work- Draw to scale and note the following as applicabie: �� ,� ' <br /> • Property Lines • Centerline of slreet � -� <br /> • Outllne and dimensions of all existing and • Indicate North = � <br /> proposed structures on the lot • Show any proposed grading changes m <br /> • Existing and proposed utili�ies • Show measurements /� � z <br /> W n � <br /> DO NOT WRITE BELOW THIS LIhE O r x <br /> PERPAIT CONDITIONS � N <br /> < <br /> 1. All cellc for inspection sha�l be made 24 hrs. in advance- phone 259•881 5. � o n <br /> 2. All work shall he performed in accordance with this permit and current City ol Everelt Design and Construction , <br /> Standards and Specificetions. �m <br /> 3. Call Location Unde•ground Service 48 hrs. before you dig.TOLL FREE NUMBER 1•800-424•5555. � m � <br /> N <br /> `/. �eww..� cx.o-�-�.nq Gn�b o,�...Y �,�,.�1� �r ...e,,.. c�rwc....� O cimi, <br /> (� � <br /> m�.. �aa�-- (�rn�w.X a.+JC fe ,�°�cvct qP/ �� zc� <br /> ` (� (� � � � /_ -i m <br /> S�-oc,..:Xa...�cX S � pt .,n t t��-tcf i�. �C �-'�c� w.v-r� � z <br /> 1 ', tl �/� .i <br /> d��t P..,� 1« l.v o rl�s 5�..'� �-,� i s rc[ o..irt r V♦ z <br /> (�f�OI� � `.a�'�� 4••..� Cw�� fGv+^'OJ aJl O x <br /> � I a N <br /> ,,,,o,,l� • l o <br /> � <br /> m <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersign�d owner/applica�t hereby agrees to hold and save harm- <br /> less the City of Everelt irom any and all claims for damages, costs, <br /> �� / expenses, or causes of action thal may arise because of installation <br /> � � 7_�y and maintenance of the improvement or other right-ohway use hereto <br /> applied for and further agrees to remove same upon notice Irom the <br /> rp oved for ConStrucliqn� � �d1e Ci�y and lo ieplace public property damaged thereby. _ <br /> � � <br /> ����-� � - � �-�y-;�_ ' <br /> � � �� ,�,, <br /> FINALINSPECTION Date '` `�" " dy <br /> Approved as Constructed gna re of Appiicant � fe <br /> WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED W�THIN <br /> everett PUBLIC WORKS DEPhRTMENT 180 DAYS OF DA��E PERMIT IS ISSI:ED AND THEREAFTER IS TO <br /> � 3200 Cedar Street BE DILIGENTLY PURSLIED TO COMPLETION.THIS PERMIT MAY BE <br /> Everett,WA 98201 CANCEL�ED BY THE C�TY UPON AtJY STOPPAGE OF WORK ON THIS <br /> Phone:259�8815 pROJECT OVER 9G DAYS DURATION. <br /> ! <br />