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Appncation For Dele L �q �99 9 / <br /> � PUBLIC WQRKS PERMIT public Works Puimlt N �' 2 y <br /> PUBLIC WOAKS DEPARTMENT -�� <br /> 3200 Cedar Street <br /> Everett,WA 98201 (425)257•8810 Building Pertnit M <br /> �n <br /> TYPE OR PRINT ONLY Puhlic Works Fee$ _ aF�7 � <br /> NOQT11 1 <T 1'OYIER CO. LLL �I�O U4�VER58 RLun T�.�nRcd.� �yQ$ ��e�—�� —u-�O <br /> Ownor Mailing Addross Cih; Zip Phone <br /> B�wck a��VKnTr►��� 'Ito Tw�Ro A� S� II00 ���►.E 1�,h 98�04 (�n�� ZZy- Nb38 <br /> Applicant MailingAddress City 2ip Phone <br /> Describe Proposed Work �� P vru E a ' �val W <br /> POY�E� P1.AN'T IfdGW�IcS FWA GQqO�h1G — LRE S1T'� � <br /> X T l. p � ' YARpS D F LL, �// <br /> PROJECTADDRESS (ifknown) IZI E.. NIpR11JF EW D . � <br /> Atlach four(4)copies plans lor proposed work•Draw to scale and note ths lollowing if applicable: O <br /> •Proporty Lines •Outline and dimensions ot all oxisling and proposed structures on the lot •Existing and proposed ulilities � <br /> •Centerline ol stroat •Indicate North •Show any proposed grading changes •Show measurements <br /> , , DO NOT WRITE BELOW THIS LINE Z <br /> _: ti PERMIT CONDITIONS: O <br /> 1. All calls tor inspection shail be made 24 hours in advance - phone (425) 257-8810 <br /> 2. All work shall be peAormed in accordance with this permit and current City oi Everett Design and ■ <br /> Construction Stand�rds and Specifications., r <br /> 3. Call Location Undarground Service 48 hrs. be(ore you dig. TOL'. FREE NUMBER 1-800-424.5555. �B� � <br /> -QP <br /> � �lJG�,� .�z`� !� dni�e �kz- �a�et �1�� 6� f/x� 0 <br /> �u�.-r��� Gv6li� cvvr,Es d�.7� o�� 8-d¢- 99 �Py a�a�l,�d� a <br /> J�,_. ///..S [<,'cv^,E S/x: LL COnl�vrM t� ��iC /�P1��.S� /'er�mif <br /> �Y' ��)iS PlIL�PGr/� <br /> �, �fe;:P c��i .S`tm�fs C Lea� 4� a LL t��rzS . � Klg <br /> �� e� �PrM� � I /� <br /> 'C"� � Y �-_1n -a5 <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> / The undersigned owner/epplicant hereby agrecs to hold an0 save hartnless <br /> GZ(G� ��,� ��¢ �� the City of Everen irom eny and all ctelms tor tlamages,costs,expenses,or <br /> pprov or ons ruc ion a e causes of action that may erise beceuse ol in:tallation and maintenance ot the <br /> improvement or other righ4ol•way use hereW,3pplied for arW fuMer agrees lo <br /> remove seme upon rwf e 1 the G r and M replace�W pe�1� <br /> FINAL INSPECTION aged t by. /�� <br /> Date � <br /> Appwvad as Constructed <br /> i a u e o pp ican <br /> VlORK AUTHOR�D BY THIS pERMR MUST BE STAFiTED WITHIN 1B0 DAYS OF DATE PERMfT IS ISSUED AND hERFfiFTEp 1$Tp BE pIJpQJTLY R1fSl1ED TO <br /> L, COMPI.Ef1C1N.7HIS PERMR MAY BE CANCELLED BY THE CRY UPON NJY STOPPAGE OF WO►iK ON hNS PFi0.ECTOVEH BO DAYS DURAiION. <br /> t' <br />