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. _ . . , , . . , I <br /> �'z'''�O ` r�mi�c wo�tis re�mn. � <br /> Oate <br /> Ll�nq Den� • / ' <br /> qpplication For , ' <br /> / I <br /> PUBLIC WORKS PERNPIT �°°'"`"°'"°�'° j <br /> Totnl Fee S <br /> Less APn� Fee Pnia S— \��— f <br /> S � <br /> �alancc due — <br /> � Print or Type Only � <br /> Phone <br /> � <br /> Owner MaihngAddress CitY Zip p—�a ' <br /> w <br /> ���� ' <br /> �Id i l� ) Cl l r'n( 1� �C�_' �C� I n(� I��e l.c)#:: I U,—,L�����'�— <br /> _1' <br /> M����mg Address City ip Phone <br /> qpplitant <br /> pGlar P I�( n��4 ��I1 �ln< < � �?flrl ���Gi ( h <br /> Describe Proposed Work _ <br /> l , n� P <br /> v` �' 1�U�'► I� =-rt� Z l�-�-�/, W <br /> �------ <br /> oq i� ' l ' r � ��'�c� <br /> Projecl Address 01 knownl � � ' <br /> � <br /> Atlach tour(4) copies ol plans lor Proposed work- Draw to scale and note the following as npplicable: � <br /> • Property Lines • Centerline of street <br /> • Outline and dimensions of all eaisting and • Indicate North <br /> proposed structures on the lot • Shav any proposed grading changes <br /> • Show measuremenis M <br /> - • Existing and proposud utili�ies W <br /> � DO NOT WRITE BELOW iHIS LINE O <br /> PERMITCONDITIONS �� � <br /> 1.All calls tor inspection shell be made 24 hrs.i�advance-phone 259•8810. <br /> 2.All work shall be pertormed in accordance with this permit and current City ol cverelt Design and Conslruclion <br /> Stenderds and Specifications. � <br /> 3.Cell Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1-800-424•5555. _ <br /> ct . c:_--CO �.J V iV�" 1 �'�.. E^ - Z`> - `-J� O <br /> � <br /> � <br /> � <br /> a <br /> ACKNON'LEDGEMENT OF CONDITIONS <br /> The undersigned ownedapplicanl heielry agrees lo hold and save harm- I <br /> less ihe Ciry of Everelt Irom any and all claims for damages. costs. <br /> r,zpenses. or causes ol acDon that may arise because ot installation <br /> �--�� ��� ��Q�_ � _Z—� and mainlenance ol the improvement or other nc�hPol�way use here�o <br /> -1—�J� � _� applied lor and further agrees �o remove same upon noticc Irom �he <br /> Approved lor Construction �a�e C;��^� �n replace public pwperry damaged thereby. <br /> y� <br /> �nt�..'( t 1 � �, � Vl l � � d � �1�� <br /> FINAL INSPECTION Date �----- Date <br /> SignaWre of Applicant <br /> Approved as Constructed WORK AUIHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> everett PUBLIC WORKS DEPARTMENT � 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200CedarSireet BE UILIGENTLY PURSUED TO COMPL[TION. THIS PERM�T MAY BL <br /> Everett.WA 98207 CANGELL[D BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> phone:259�8810 PROJfCT OV[R 90 DAYS DUR�TION. <br />