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_ � <br /> t <br /> r ,1 <br /> � <br /> r <br />�I �_ Puobc worxs Permit• �� /�� <br /> Date���3 eico u�oi.. <br /> Iqpplicalion For <br /> ORKS PERMIT °"°"`""°""`° Y an o " <br /> PUBLIC W "'B1pe <br /> � lens POOL Foe Pe�O S ^ � <br /> Baiance Due s �O �U <br /> Print or Type Only G'y13a <br /> � � � +�a�� (� �,�1 /'1�)/ C�)p�'i„n2� �S�Z - F-H9Y <br /> ��/ Phone <br /> Owner <br /> Mailing Address �°Y Z�P <br /> . � C.ry Zip Phone <br /> ApDlican� Mailing Addiess <br /> Descdbe Proposed Work _ri�� C � <br /> W <br /> � , � mo r <br /> Prolect Adtlress(if known) � <br /> Attach lour(4)cop�es ol plans for proPosed v:ork-Draw to scale and nole the tollowing as applicable: � <br /> • Property Lines • Centedine of street <br /> • Indicale North <br /> • Outline and dimensions o�all ezisiin9 ai�d � Show any proposed grading changes <br /> proposed structures on the lot � Show measurements M <br /> • Exislirg and pioposetl utiliiies W <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS � <br /> t. All calls for inspection shall be rnade 24 h�s. in advance� pho�e 259•881 5. <br /> 2. Ali work shall bo pertormetl in accordance wilh this permit and current City ol Everett Design a��tl Cc��irucl�on <br /> Standards and Specitiwtlon� � <br /> 3. Call Localion Underground Service d0 hrs.belere you dig.TOLL FREE NUMBER 1•B00•424•$5 . <br /> � 1 S�Alv.+n�C .�. '�'NC� Q(PA Cf �e v�Pw dr,•�P.,.�q� � <br /> �FIE eX�z���� (� <br /> vti.�sF bc �e w. o., �9 a�.9 � a ��ac�.Y w,�-�. co� cre�e. <br /> ��� � <br /> –�-h�c�< " � <br /> � -Eo re w.o.,� -41+e ex� s�-�ha <br /> �. -T1�e �;,��I,�a...� u�rees I O <br /> R� 0.i SMow.n Or� �t Su7w.��� w.��•'� <br /> df�vCW � <br /> (� ,,.., o..,�S nF �5�-.,,.t�,,,� � ,.e„� dr,,,< „��7 n <br /> e,,.91 SarRS� . �0.�) o„e c�Yi.�ewa7 w.11 loe ct.�low�.Y <br /> pwt-� -�ce 11 +�� y�ree-4' -�.�.�aS t_� <br /> ACKNOWLEDG MENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees to hold and save harm� <br /> less the Ci�y o� Everelt irom a�y and all claims fOr tlamages, costs, <br /> I expe�ses, or causes o� action !hal may arise because of installalion <br /> G and mainlenance of Ihe improvemenl or other right-obway use hereto <br /> !�— O' ���� applied br a�d lurther agrees to remove same upon notice Irom ihe <br /> Date City and to replactt Public properry damaged thereby. <br /> L pproved for Consiructi n � <br /> � /b��'��_ r�! /� �� .�� <br /> Date . �l� , ��.- . <br /> I ALINSPECTION Date <br /> Sign� o Ap icanl <br /> qpproved as Consiructetl yyQpK AU7HORI2EU BY THIS PERMIT MUST BE STARTED WITHIN <br /> everett PUBIIC WCIRKS DEPARTMEN7 180 DAYS OF DATE PERMI7 IS ISSUED AND THEREAFTER IS 70 <br /> 3200 Gedar Street BE DILIGENTLV PURSUED TO COMPLETION.THIS PERMIT MAY BE <br /> Everett,WA 98201 CANCELLED BY TNE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> � e Phone:259�8815 PROJECT OVEFi 90 DAYS DURATION. ` <br /> L � <br />