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_._-- <br /> .� <br /> �. Fobl'ro Wa�b Parme� - <br /> giEp.Deo��� 36117 <br /> Date 3—�2� <br /> APPliwlion For Pobbc Wo�Mf Fee <br /> RMIT TotelFee s- <br /> PUBLIC WORKS PE «.,�Po,FeeP.,a .�— <br /> g�I�nce Dm s---- <br /> print or TypB Only <br /> 98203 347-8521 <br /> �e�tt Pnone <br /> 3608 Shore Ave C1`Y Z�P <br /> Bill IY�bEIteOII Mailing AdAress <br /> Ow�er �ds 98020 775-9650 <br /> nst. i1805 — 98th Ave W Z�P Phone <br /> P.T. � City <br /> Mailing Address <br /> qpplicanl <br /> Constsuct Swimmi <br /> t <br /> Deacribe Proposed Work <br /> W <br /> H <br /> - <br /> licable: /w <br /> Proiect Addresa(if known) �� <br /> pttech tour(4)cop�es ol P�e^g}Of Proposed work• Draw to scale and note the�o��a`�+ing as app <br /> � Cenlerline of street <br /> rt ���88 • Indicate Nor1h rading chenges � <br /> � prope Y � ghaW any proposed g <br /> • Outline and dimenaions ot all eaisling a�d � Show measurements <br /> propoaed atructureaed utlt�es O <br /> • Existln9 end Vropos <br /> DO NOT WRITE BELOW THIS LIPlE <br /> pERM1T CONDITIONS � <br /> t.All ce�ls lor Inspecl rmit and curtent City ol Everett Desipn and Constructb� � <br /> �on eha�l be made 2a hra�n edvance-ahune 259'�1 � <br /> 2.All work shNl be Pertifcateona �o�ence wiM lhis Pe 245555. <br /> Stenderde�^d� O <br /> 3.Csll Locellon Undero�^d g°^'�ce 4B hrt.batare You dig.TOLL FREE NUMBE111 <br /> � �j � ;z �V� �4 �1,cr�" h��✓fh�d • � <br /> � N <br /> � ��,' �/�UST 0�� �� S�v� ��L � <br /> I I ��>✓N�fi ( o. <br /> ��� �T �� <br /> '� n /� /q rl�� .s��'��' <br /> � J�j�f�Sl I v S ��/'�_ ` ^C�����OFCONDITIONS <br /> � � � <br /> 7" he undersigned ownerlaDP��cant hereby egrees to hold end seve arm- <br /> less lhe CitY ot Everet� from any and all cleims for dertiBges. �og�� <br /> erise because of Insle��elion <br /> expenses, or causes of ection tha ma <br /> use hereto <br /> and mainlenance of the improvemenl or olher right•ol-waY <br /> aOP�ied for and furlhubl c9PioPe�Y�damaged herebyn �olice Irom lhe <br /> Date City and 10 reP�ace P <br /> qpproved for Construction �. � � �A�` ,y�� f�Y <br /> � �� Date <br /> Date nature ol Applicant WITH�N <br /> Sig <br /> FINAL INSPECTION y�ORK AUTHORIZ[D BY THIS PERMIT MUST BE STARTE <br /> qpproved as Construcled 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> PUBLIC W�RKS DEPARTMENT gE DILIGENTLY PURSUED TO COMPLETION.THIS PERMIT MAY BE <br /> � 3pp0 Ceder Street CANCELLED BY THE CI7Y UPON ANY S70PPAGE OF WORK ON TMIS <br /> Everet4 WA 98201 PROJECT OVER 90 DAYS DURATION. <br /> phone:259-8870 <br />