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" 'r,':x^...�.� . .. �,'''.,C'.v� <br />.� <br />"�� �� �,t,1J ' <br />% <br />� � � Appllcallon For <br />PUBLIC��WORKS PERMIT <br />Print or Type Only <br />. .�.y.. .. , , . <br />. �y ' - . ` <- �`. � . <br />I v�eiK won. v.,mn . 7I Y� � <br />�----- ; <br />eiap. o.ot • <br />weik wo�a F.. 7 �I <br />To�N Fw i_d' U. n U <br />L�u Appl FN P�IE _ "�. <br />B�I�nnD�� i_.11.i. [lt��� <br />�rc.; �::`� <br />!'::7'!Y Ktn �;��Ft 936 rvi;ittun IIlvri: t,verrtt, �aaflhirx�ccvi 9r]2U3 259-2398 <br />Owner Meliing,lddress , City Z� <br />P Phop� <br />..._.....n.._....,.,., �iry Zip Phone <br />Deacnbo ArOpOsed yVotk "''���"riw� �r �, �� rmt Gr.i��? 1Jny Ha�r�y �p I,f�t,Q 1Q yyj jy� j�le hCiLJiItY <br />!1V.'.:I1C`:l .�47LLOi1 113 '�(yL Y Htlfl AOQ�IIn Yn n u�i: .. .� <br />.. . ___..._ s_ . <br />`�'rc=;..+=::t l'�,: oE �uld lot 15 for a dietFtrta: of. <br />-�-,".—. <br />ProlsctAddressllfknobl�J� �-4�' 1.4 �i�i 15 ai� � by � <br />��: ���4> � t:'; c��: a+rusr uz.mos L�t 4 to L� <br />�fr�c:c, tl;vioe scr�th Eesterly <br />s � . stsr:c:¢ o ��' i1--�. <br />�lrn c�P ���� T•-� rrt <br />md le�c�nl oai►a�r�t+� xill h,4 <br />Attec� �our (4) copiea ol plens for proposed work • Draw to scele entl note the fol owinp as applica6le: <br />• Property lines • Centerline of sVeet <br />• Outlina and dimenaiona ol all existinp and • Indicate North <br />nroposed structures on the�lot • Show an <br />• Existinp antl proposad utilities Y P�oPosed grading chengea <br />_ • Show measuremenfs <br />PERMIT CONpITIONS � <br />1. All callo lor inspection shall be made 24 hrs. in adv�ce - phone 259�8815. <br />2. All work shelt be paMormed in accordance with this permit and current City ot Everett Design and Construction <br />SlanderAs and Specifications. <br />3. Call Locetion Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 7-800•424•5555. <br />. I . <br />� :-i <br />�provetl �or Conslruttion <br />` , � � . . o . _ � 1 <br />� � �' . . j • �. , � <br />i-���- /-� j1:r% <br />• Date <br />NAL INSPECTION ,� Date <br />�proved as Constructed <br />everclt PUBLIC WORKS DEPARTMENT � <br />� :1200 Cede� Slrael <br />rverclt, WA 98201 <br />Phone: 259-BB15 <br />. � , �- . , n i>. <br />.�, ,�.;�., :,,.:, . <br />, <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The u�dersigned owner/epplicant hereby aprees to hold and save herm• <br />leas the Cily ol Everett }rom any and all clalmn for Aamepe0. coN�, <br />expenses, or causes ol actlon that may erisa because ol inetall���pn <br />antl malnlenance of the improvement or other rlghFol-way uae heiato <br />epplied for and IuAher agrees to remove same upon notice Irom Ihs <br />City and to replace publlc property.dameped thereby. <br />i- � <br />� !�/�� � (!( i (..r �f i <br />Signeture ol Appli6ent Date � � <br />� WORY. hUTHORIZED BY THIS PERMIT PiUST BE STARTEO WITHIN � <br />1tl0 DAYS OF OATE•PERMIT IS ISSUED AND TMEREAFfER IS TO � <br />BE DILIGENTIY PUASUED TO COMPLETION. THIS PERMIT MAV BE , <br />CANCELLEp BY THE CITY UPON ANY STOPPAOE Of WORK ON THIS � <br />PROJECT OYF.R 90 DAYS DURATION. � <br />