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DateJ�.l+�ly[J� � PuDlic Wo. �Permil• � �
<br /> � i eiov�Deo�• �
<br /> npplicalion For
<br /> PUBLIC VI/ORKS PERMIT PubTot�Fe�Fe• s
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<br /> 8,�.�.��. . s lyc��r
<br /> Print or Type Only
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<br /> �mcn-Gr)a��a�ti . .. ilynn SG- F`r'�. �cr.��p 1�235 �ialln�,iP (qlf� � ., , .
<br /> Phone e �
<br /> Owner ' _ . Mailinp Address Ciry , . . Z�P ri- 'i ��..�.:� ��
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<br /> � � \A iri Z � � CIt , 21P . . � Phone . ;. � i� iAta �,
<br /> Applicant , Mailing Address Y � : ,:.
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<br /> � Descdbe Proposed Work - ,���� {
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<br /> �� Project Address(if known) � O 2O— � .�, ,'��
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<br /> Altach four(4)copies ot plans for D�oDcsed work-Draw to scale and note Ihe follow(ng as applicable: :' y t � �`� . ,,
<br /> � . :. � ProPertY Lines . - . .; . .. .. • Centedine ot street _, ,.�.. i Sq.�� �c�, r i �� r�
<br /> � '- � • Outlino and dimenstons of all existing and • Indicate North ' � p. .
<br /> � • Showanyproposedgradingcheages � � � y, i .�,�,.;.
<br /> � . . proposed structures on the lot . . � �.��r , :- ;��-
<br /> ' � � � .. • Eaisting end proposed utilities • Show measurements � , y,; Y, i.,Y, .t :A�y.
<br /> DO NOT WFITE BELOW THIS LINE . : - f• O
<br /> . . . . .�.. ... . . � .. . .. .. ' : �. • ... `4. . ± '�� f �l R�J
<br /> rERMITCONDI710NS . � . �'r ��r� • j
<br /> 1. All calls for inspection shall br made 24 hrs in advance•phone 259•8815. e } �� ,s � '
<br /> .p-=�. � � . 2. All work shall be pertormed In accordance with this permit and current Gty ol Everett Desi n and ConsSructlon � �' .
<br /> � � • � Staodards end Specilications � � - "!�-� "�� ' I
<br /> ' � � . 3. Call Locatlon Underground Service 48 hra bebre you dig.TOLL FREE NUMBER 1-800•424-Ci555 � �.,�. r i '`'l� �� �,
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<br /> ' ACKNOWLEDGEMENTOFCONDITIONS �'''�T��=F�La
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<br /> Tho undersi9ned owner/appilcant hereby agrees to hold and save herms`r.
<br /> less the City of Everett Irom any and all claims tor damages; coet�•� �
<br /> expenses, or causes of action that may arise because ot installetlon �
<br /> D Q�/ � and maintenaue of the improvemenl or other right•ohway use herelo il .
<br /> � c O applied for and lurther agrees to remove seme upon notice trom She .
<br /> ApptCved tor onstrq ion �a� Ciry and to replace public property demaged lhereby. --�� ;�.r��_-- �
<br /> � r_
<br /> FINAL INSPECTION �a1e Signature of Applicant . Date ��
<br /> Approved as Constructed
<br /> WORK AUTHORI2ED BY THIS PERMIT MUST BE STARTED WITHIN
<br /> everett PUBLIC WORKS DEPARTMENT �gp DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TU
<br /> � 3200 Cetlar Streel BE DILIGENTLY PURSUED TO COMPLETION.THIS PERMIT MAV BE
<br /> Everett,WA 98201 CANC;:LI.EO BY THE CITY UPON ANY STGPPAGE OF WORK ON T"IS
<br /> pione: 259-8815 PROJECT OVER 90 DAYS DURATION.
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