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�Y� f: .: .... . <br /> �s,.,.._ <br /> � <br /> �� .._.. � i4 � <br /> M <br /> Date 1�.-131 P�o,�.•,o�..>�,m,�. <br /> h-�`� emc.oso� • Q I /�064 <br /> qpplicatic��w� <br /> PUBLIC WORKS PERMIT '°°°""°"„°° 5 <br /> � N Tcul Fca <br /> •.1 l0fa ROOI fee Pa�G 5 <br /> yy Bdldn[G�u! 5 <br /> � H Print or Type Only <br /> 9��A <br /> i1ALENZ, DONLTTE YO BOX SL11 EVERETT 98201 252-8871 <br /> � � y,.�'C Owner Mai{ing Address Ciry Zip Phone <br /> '� N"�D <br /> y~ OWNER <br /> xp Applicant Mailing Address City Zip Phone <br /> � HC <br /> � �g Describe Proposed Work BATHROOPi ADDN (DORMLR) <br />� �� n <br /> E x H� <br />� � hi H � <br /> � <br /> ~ 2521 PfAPLE AVG H <br /> O l7 tA Prolett Atldress lil knowN . <br /> ��� Attach four(a)copies ol plans tor propoSeG wo�k-Drew to scale and note the lollowing as applicab�e: i <br /> y �N • Property Lines • Centedine ol streel <br /> N • Outline and dimensions of all existing antl • Indicate Norih / <br /> � -��- �- prcoosed structures on the lot • Show any proposed grading char7es <br /> I <br /> • Existing antl proposetl utilities • Shcw measurements � <br />!I DO NOT WRITE BELOW THIS LINE � I <br /> PERMIT COND�TIONS <br /> t.All calls for inspection shal�be made 24 nrs.in advance•phone 259•8810. � �� <br /> '� w� 2.All work s�all be pedormed in accordance with this permit and current City ot Everett Design and Construction ► <br /> .�� Standards end Specilications. , <br /> 3.Call Location Undergroun0 Service 48 hrs.before you dfg.TOLL FREE NUMBER 1•800•4245555. � <br /> '^' -�L //' � � <br /> ��' %� ♦ • ./ /'^•1 .• <br /> �r'G�licc-e l.�l:,z/i ��.,;.r..< �C.. f�<-r:<< . .- <br /> � � � <br /> l� <br /> a� . ._Y .:: i � . <br /> i <br /> 1 ( � ro � <br /> �osr►Nc a <br /> --____ <br /> , ,�, - <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/apPlicanl hcreby agrees to hold and save harm� <br /> i � <br /> less the City ol Everett Irom any nnd all claims lor dameges, cos s. <br /> � erpenses, or causes af ection that may arise becnuse ol (nstallation <br /> � - and maintenance ol the improvement or other righ4oFway uso herelo <br /> �a epplied lor and luriher agrees to remove seme upon notice Irom the <br /> i Approved for Construction Date Ciry and to ieplace pu6lic Droperty damaged thereby. � <br /> � FINAL INSPECTION Date Dete <br /> : ppproved as Constructed Signalure ol Applicant <br /> WORK AUTHORIZED BY THIS PERMIT MUST 8E STARTED WITHIM1 <br /> , �A�� PUBLIC WORKS�EPARTMENT 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS .TC <br /> 3200CedarStreet BE DIUGENTLY PURSUED TO COMPLETION.'iHIS PERMII'MAY BE <br /> Ereret4 WA 98201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THI: <br /> Phone:259-BH10 pROJECT OVER 90 DAYS DURATION. <br />