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�/i3/�s <br />D8t6 <br />Application For <br />PUBLIC WORKS PERMIT <br />Print r,r Type Only <br />�i'riada Granada P.0. Fos 40 <br />Putlic Worka Permit • O✓ '� �/ � <br />eiee.oePt� �?5/14979 <br />PuElic Worke Fe9 <br />Total Fea � <br />Less ApP� Fae Paitl 5 <br />Belance Oue S ����U� <br />7Zdmouds 9P020 774-415E <br />Owner Mai4ing Address City Zip Phone <br />Same <br />Applicant <br />Descrlbe Pronosed Work <br />Mailing Ad�ress <br />Construct Sinale Family Residence <br />ProJect Address (it known) ✓�/lT — <br />�n <br />Attach tour (4) copies of plans for proposed work - Draw to scele and note lhe following as applicable: <br />• Property Lines • Centerline of street <br />• Outline and dimensions of all existing and • Indicate Norih <br />proposed structures on the lot • Show any proposed grading changes <br />• Ezlsting snd proposed utilltics • Show meacurements <br />Phone <br />PERMIT CONDITIONS <br />I. All calls lor inspection shall be made 24 hra in advance - phone 259-8815. <br />2. All work shall be peAormed in accordence with lhis permit and current City of Everett Design and Construction <br />Stendards and Specifications � <br />3. Cell Location Underground Service 48 hra before you dig. TOLL FREE NUMBER 1-800-424•5555. <br />� f��i�liCQivT TO k'Fino!/E E'-Y�.� i/i:/� I�/'�l�r�c'd� <br />A/7/D ��f�!_ AL F / d/TN �'LC /�Fil� yT f U.t 6� <br />��T�E,� �' _s.��� f,��a cK �E.� ciTt/ STG�t/,Od�OS, <br />/ <br />✓�, ii �iPc /S f�Qt_��.r= EG� L�a%Dc'� Ti/_r f=,c c,/�o.SN !� <br />l�k'�vE<�JA� ,� Scn GnT ,�' -.��Siv ,=�p�: E ,4�C��55 <br />%(_' Th'Fi.�' (c./��rEi:� _'.�c:�:�iCF. <br />/� . <br />""�i, i� 'G.'?(� a! -, _�— � `� �- <br />Approved for Constnictlon /bate <br />Approved as Constructed <br />everett PUBLIC WORKS DEPARTMENT <br />� 3200 Cedar Street <br />Everett. WA 98201 <br />Phone: 259-8815 <br />W <br />H <br />� <br />� <br />O <br />� <br />� <br />O <br />a <br />ACKNOWL�30GEMEN7' OF CONDITIONS <br />The undersigned owner/applicant hereby agrees to hoid and save harm• <br />less the City of Everett irom any and all claims for damages, costs, <br />expenses, or causes of action that may arise because of instattetion <br />and maiNenance of the improvement or other righl-ohway use hereto <br />applied for and further agrees to remove same upon notice from the <br />Ciry and,to jeplace public property damaged there6y. <br />' " � / � <br />--��1���.'%�' �i % • i <br />' � ���.�-�� � / �s � <br />_ _�,1 �., � �, ( v <br />Signa(ure ef App�icant � � Date <br />WORK AUl"HOR�ZED,BY THIS PERMIT MUST BE/STARTED WITHIN <br />1P.i1 DA"S OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATIOPI. <br />