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i <br /> Appiic,tion Far Date _�� <br /> � PUBLIC WORKS PERMIT gq�'io�-oz.t <br /> PUBLIC WORKS DEPARTMENT Public Works Permit s <br /> 3200 Cedar Street M Buildin Permit k � �" O <br /> Everett,WA 98201 (425)257-8810 m 9 <br /> TYPE OR PRINT ONI�iQ POSTING `�� � 5 ZOO4 � public Works Fee$ 2SI <br /> �r�n�.t✓�cG Gvar. �'925�'" <br /> �d��'s �le�f-,r�� Px�; Irl�na <br /> Owner Mailin. ddress Ciry Zip Phone <br /> ZC�i VYc�rl�orG �VG �l[,raf� �f62D I 425�y� -z I 0�1 <br /> Applicant Mailing Addrecs City 7.ip Phone <br /> Describe Proposed Wor�c ��L�V� ����YOe�Q.��f n'' �'i • � <br /> i � <br /> � <br /> Y/ <br /> PROJECT ADDRESS (ii known) �2�0 .�'��U�AVQ W <br /> Attach four(4)copies plans for yroposed work-Drzw to scaie enri ncte ihe following il applicable: O <br /> •Property Lines •Outline and tlimensions of all ezisling and proposod structures on ihe lot •Existing antl proposM utilities <br /> •Cenlarline ot street •Indicate North •Shuw any proposed gratling changes •Show measuremenls <br /> DO NOT WRIT� BELOW THIS LINE Z <br /> PERMIT CONDITIONS: O <br /> 1. All calls for inspection shall be made 24 hours in advance- phone (d25) 257•8810 <br /> 2. All work shall be peAormed in accordance with this permit and current City oi Everett Design and � <br /> Construction Standards and Specifications. <br /> 3. Call Location Underground Service 48 hrs. before you dig.TOLL FREE NUMBER 1-800-424-5555. ♦/� <br /> �� �s �� ��►�� Pr�� d� �la�qy �O <br /> a <br /> ACKNOWLEDGEMENTOFCONDITIONS , <br /> � �/MM The undersignetl o edappli hereby agrees to hold and savo nartnless <br /> � �A� y' I (�/n p � I g�'(� Mc Ciry ot E fr a and I ' s for damages,costs,eKpenses.or <br /> !A � � i F-c� l causes cfion M erise e.au o1 installation and maintenance of the <br /> ppi ve 'r on/si�c ion 3�- ����Pm ment or e �gh4of- a us hersto�plied for and further agrecs ro <br /> � /„(( / rem e sa pon tice t�m t e iry and replaee public p[npery dam� <br /> , i � ._�- �-1-�� ' G � y9 �h y. � <br /> FINALINSPECTION Date � L� •,� GC' <br /> Approved as Constmcted �1.. � � � 7 <br /> . i ureo p a <br /> WORK AUT}iOqIZED BY TNIS PERMR MUST BE STAfiTED WfTHIN 1B0 DAYS OF DATE PERMR I ISSUED PND TFERFAFTER IS TO BE DILIGENTLY PURSUEp 7p <br /> COMPLEf10N.hilS PERMR MAY BE CANCEUED BY TiiE GTY UPON MN SlOPPAGE OF WOFtlC ON 11#S PRO.ECT OVER 90 DAYS WRATION. <br />