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DateS��ca_ <br /> �•�� ,-��:�,.,���,�n�. <br /> APP�iC�tion For um;�p,.ni • 36744 <br /> PUBLIC WORKS PERMIT P����,vo,�,�ee <br /> ,o���F.� s�— <br /> .y�� ��sspooi ree va�o 5 <br /> � Print or Type Only o.,�,��,.o�� s <br /> O '.V,.y'tC <br /> C H <br /> � y y _ Nancy Gribble 469). Silvertip Lane Everett <br /> N�� Owner � k'A 98203 259-6005 <br /> y 1-I P;ailing qrdress City <br /> K y� Z'� Phone <br /> O x O �eL <br /> � H � APPlicanl — <br /> V�!-� Alailing AtlCreSs Cily Z�� <br /> t <br /> Phor. <br /> z <br /> Q�y ty o��scnbc Proposea work Enlarqe bathroon & ine.tall hot tub <br /> H � g — <br /> �i]Y (] <br /> zH� — <br /> H ��"� y Proiect Address pf knownl 9641 Si 10� <br /> g y ���— '"� <br /> n ty N Attach lour�4�copies of plans for proposed woik� Dmw lo scale, <br /> �ntl notc Ihe lollo�vinp�s appliCaUl�: <br /> �� r � Prppe�ty L�ies • Centedine ol sireet �� <br /> x y y • Outhne ac]dimensions ol all existing and • Irtlicate North ♦^ <br /> y � y pronosed slruciures on the lot � Sha` a� v, <br /> • [xisting and propoSeA utilities Y P�opOSetl gratlin9 clian.�es <br /> • Show measurements <br /> � DO NOT WqITE BELOW TIiIS LINE m <br /> �% <br /> PERAtIT CONDITIONS O <br /> � 1.All cails for inspeclion ahall be made 24 hrs.m advance-phone 259-$$10. <br /> � _ 2.All work shall be pedormed in accordance with ihis pennit antl currenl City ol Everett Lesign and Construction � <br /> �� Standards and Specifications. <br /> � 3.Call Location Underground Service 4B hrs.belore you diy.TOLL FREE NUMBER 1•800•4243555. <br /> � �� L'IG<'. C��� [/��-_- �Jt�. . _ . C :� (.,�-� � � Z <br /> ✓ � <br /> . f. , <br /> �� ���� � � ..�C�� . .. � <br /> �-,_ a <br /> � ,_ <br /> I�. ACKNOWLEDGEMENT OF CONUI710NS <br /> . The undcr,iqneA owner/applicanl herebyagrees�o holA and 5ave harm� <br /> � less Ihe Gty ol [verett Irom any antl all claims tor tlamage:.. cosls <br /> expenses. or causes of action ihal may anse 6ecause of inslnllotwn <br /> antl main�enance of the improvement or other righPohway use heieto <br /> APPmved lor Cnnsiruction applied for and luriher a9rees to remeve same upon nohce hom the <br /> Date City and lo replace public pronerty damageA IhereUy. <br /> FINAL INSPECTION <br /> APnroved as Cons�ructed Date <br /> � Signaturc ol qpplicant � �, <br /> /�B� PUBLICWORKSDEPARTMENT WORK AU7HORIZEO BY THIS PERMIT MUST BE STAR7ED JJ�iHIN <br /> �� 9200CetlarStreel 1F10 DAVS OF DATE PERMIT IS ;SSUED AND THERE <br /> Everetl WA 98201 BE �ILIGENTLV PURSUEO TO COM1IPLETION. THIS PERAIIT MFY BE <br /> Pi:onc�.25g�8�10 CANC[LLED 8Y 7HE CITV UPON ANY STOPPAG[OP WORK ON THIS <br /> � PROJECT OVER 50 DqyS DURATION <br />