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• �ppbwtion For Date 'O ^/� � �• / <br /> � PUBLIC WORKS PERMIT publicWorksPertnitk .�//�/ <br /> PUBLIC WORKS DEPARTMENT <br /> 3200 CeAar Street <br /> Everetl,WA 98201 (425)257-BB70 Building Pertnit 8 <br /> TYPE OR PRINT ONLY Public Works Fee$ <br /> �� <br /> 88 <br /> �ir b� �Y�K.S 9F4 h -� �ol�U� 1�, �N...tirr w�Q9.�o��-J�d�l� / IV_, <br /> Owner Mailing Address - CiN Zip Phone <br /> Q c��,q,nc.� �/a/vS 5'Fo 7 z NP 4�� S I�r �����t! /� F�n7P 4 ZS2YiS'49s�T- <br /> ApPlicant Mailing AOOress� Ciy Zip Phone <br /> Describe Proposed Work S �1 O iS l K t� W <br /> , � <br /> `� fL� (�D �i S e � <br /> � <br /> PROJECTADDRESS (if known) CI'7 b" 1 �� �y��� 'S� �bE�� � '^'� � � <br /> 0 <br /> Attach fcwr(4)copies plans tor proposed work•Draw to scale anA nole the tollowing it applicable: � <br /> •P�openy lines •Outline anA dimensions o�all ezisting and proaosed structures on the lot •E�isting and proposed utilities <br /> •Centerline ot street •Indicate North •Show any proposetl grading changes •Show measuremanis � <br /> DO �JOT WRITE BELOW THIS LINE <br /> PERMIT CONDITIONS: O <br /> 1. All calls for inspection shall be made 24 hours in advance - phone (425) 257-8810 <br /> 2. AII work shall be �Aormed in accordance with this permit and current City oi Everett Design end � <br /> Construction Standards and Specifications. . <br /> 3. Call Location Underground Service 4B hrs. before vou diq. TOLL FREE NUMBER 1-B00-424•5555. /A <br /> ♦// <br /> O <br /> � a <br /> ,i <br /> � <br /> �� I <br /> � <br /> �� � <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> � /J The undersigned ownerlapplicant hereby agraes to holA an0 seve hartnless <br /> _ i',y � Ihe Cily of Everetl Irom eny and all claims tor Oemeqes,cosb,ezpensea,or <br /> � OP► causes ol action Mat may erise becauee ol Insfeliatlon and maintenence cl the <br /> {,rove s ory 0 e �mprovement or other rightot-way uee herero applied for end turlher egrees to <br /> d � ���- remove same upon rance hom the Ciry erW ro replace pubAc propeny Oam• <br /> , �:.�r,o���.._ (� _ �¢-95 aaean,erenY. <br /> FINAL INSPECTION Dale S��( (e •� �/- !! <br /> Approved as Constructed <br /> � r o �cen eCe- <br /> N�ORK AUhiOR�BY THIS PERMR MUST BE STARTED WI7HIN 180 DAVS OF OATE PEW+IfT IS ISSUEf1 MD 7FEF�AFIER IS TO BE Ol10HJTLY PURSUED TO <br /> OOMRETION.hi1S PERMR M4Y BE CANCEIlEO BY TFE pTY U�'ON ANY STOPPKiE OF VVl7FiC ON 1MS PRQ�CTOVER 00 DAYS IX1RAT10N. <br />