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l Pu��m Works Parmll� �� <br /> Date��=92 <br /> e�ea oeo� • 46070 <br /> qpplicalion For pybliC WOfkp FCB S,-� <br /> Tota1 Fee <br /> pUg��C WORKS PERM� �esaFoo�FeePa�Os�-- <br /> BaiancaUuo 5—�--�— <br /> Print or Type Only <br /> EVERE7T WA 98203 258-1652 <br /> 430 VIEW RIDGE DR _ Z�p Phone <br /> ROt2 PAYNE Cny <br /> Mailing Address <br /> Owner <br /> �— <br /> OWNER Zip Phone <br /> Mailing Address Ciry <br /> qpplicant <br /> ._---- <br /> Describe Proposed Work <br /> SFk ADDN <br /> W <br /> -- I- <br /> - <br /> Project Address(if known) � <br /> � • Centerline ot street <br /> Httach four(4)copies ol plans for proposed work- Draw to scale and nole the following as applicab e: <br /> � property Lines • Indicate North <br /> • Outline and dimensions of all existing and � Show any proposed gradi�ig changes � <br /> proposed stmctures on the lot • Show measuremeats <br /> • Existing and p�oposed u�ilities � <br /> � DO NOT WRITE BELOW THIS LINE <br /> PEFMIT CU�JU�TIONS � <br /> 1.Ali calls for inspection shall he made 24 hrs.in advance-phone 259•8810. <br /> 2.All work shall be pedormed 1n eccordence with this permit and current Cily of Everett Design and Construction � <br /> Standerds end Specilications. <br /> 3.Cell Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1-BOU'424•555 • O <br /> . <br /> , „�< <br /> '� �� �� <<ti<<� � <br /> ���,��� �-�3Z�'� /�'" � <br /> ,���y/9, <br /> � <br /> � <br /> .��,<< � � a <br /> /� � �' �c�' �.�.� .c,} <br /> �>� ?'��:,:�� .` ��u�� i <br /> C, ,�.- <br /> ��� �. <br /> ACKNOWLEDGEMENT OF CO e�o�hONd and save h�rm- <br /> The undersigned ow�er/applican��1efnd alal9claims lor damages, cosls. <br /> less the City ot �verett irom any c <br /> �--� expenses, o� �auses of action Ihat may a�ise because of installation <br /> aPP�ledl�oe and furtheeagrees to eemove'same9 Pon noticeslrom the <br /> Dale Ciry and to replace public property damaged thereby. <br /> qpproved lor Conslruction <br /> Date <br /> Da�e S�9natu��icant <br /> FINAL INSPFCTION <br /> ppproved as Constru�ted WORK AUTHORIZED 8Y THIS PERMIT MUST BE STARTED WITH <br /> PUBLIGWORKSDEPARTMENT 180 DAYS OF DATE PERMIT IS ISSUED AND THEFlF.AFTER IS TO <br /> /�r� 9200 Cedar Sireet BE DILIGENTLY PURSUED TO COMFLFTION.THIS PERMIT MAY BE <br /> Everetl.WA 90201 I PROJECI OVER 90 DAYS DURAT ON.STOPPAGE OF WOFK ON THIS� <br /> Phone:259-8810 <br />