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� �kalion I�or <br />PUBLIC WORKS PERMIT <br />PUBLIC WORKS DEPARTMENT <br />3200 Cedar Slreet <br />Everen, WA 98201 ;425) 257•8810 <br />TYPE OR PRINT ONLY <br />W P I� 4 L� <br />Owner <br />T <br />Applicant <br />Describe Proposed Work _ <br />PROJECT ADDRESS (if known) <br />Mai�mg Addro� s Gry <br />sm�t� <br />Mailing Addre�is Ciry <br />'L� G��ir � <br />0 v Go-� �4 <br />O G GTy , �a <br />Data � — � 1 _ ` � <br />Public Works Pertnit N � <br />Building Pertnit M <br />Public Works Fee $ ���'.�([�_ <br />e-r7 � ti/A• �87.03 <br />�- <br />Zip Phone <br />353 - S'�S8 <br />2ip Phone <br />� � �F W <br />� S��T � <br />�1�N 1 D F � � <br />q o I 9 U� f�ilc vJ <br />Attach lour (4) copios plans lor proposed work - Draw to scale end noto the following il applicable: <br />• Property Unes • Ou!lina end dimensions of all existing end pmposeA sirucWros on the lot • EaisBng and pmposed WiliUes <br />• Centorline of streat • Indicate North • Show any proposed grading charryaes • Show measurements <br />DO NOT WRITE EtELOW THIS LINE <br />PERMIT CONDITIOP�S: <br />i. All calis for inspection shall be made 24 hours in advance • Fhone (425) 257-8810 <br />2. All work shall be performed in accordance with this permit and current City of Everett Design and <br />Construction Standards and Specitications. <br />3. Call Location Underground Service 48 hrs. before you dig. TI)LL FREE NUMBER 1-800-424-5555. <br />`� .� n s�r/� s�/f" �-��� 6/-u'r C. �� S7� <br />-t-5`J <br />uPy-.. <br />FINAL INSPECTION <br />Approved as ConstmcteA <br />5 7,�1�s <br />C /-Pa�Y�- Q`/ ��'r �e�' <br />,,����L �5 <br />��� � �� <br />Date <br />t,� (� GOr�^ � <br />� <br />�;'C�' ��03 <br />Z.�- <br />w�-. <br />� �w�f0�3 <br />� <br />ACKNOWLEDGEMENT OF CONDITIONS <br />lTx� undersigned owner/applicant hereby agrees to hob and save hartnles5 <br />the Ciry ol Everotl trom any and all claims lor damages, costs, ezpenses, or <br />wu: os ui action ihat may erisa berause oi installatlon aM maintenance ol Ihe <br />improvement or other nghUol-way use hereto applied Mr end turther egrees to <br />re o e:ame upon notice Irom e'ty and ro replace public property dam• <br />a �e <br />-a�-9 <br />i urc o n a e <br />WOFiK AUT}iOR�D BY 1HGS PERMR MUST 8E STAF7fED WfTHIN 1B0 DAYS OF DATE PERIMT IS ISSUED AND TMEi�PF�ER �S T� BE OL1GENfLY Pl�1ED 1U <br />CDNPLETION. THIS PERMR M4Y BE CANCELLED BY T}E IXTY UF'ON ANY STOPPAGE t�F'M�fiK ON T}NS PHO�ECT OVEfl 80 DAYS DURATION. <br />