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�r <br /> � <br /> -1-Y.�i:'Tl �- 7u``7�? �-i-L;.�"�`� Puo'�rVla�.sPerm�tr _� �U� / � <br /> Date N - Z? <br /> oiye.o�oi.._ - <br /> Application For <br /> PUBLIC WORKS PERMIT °°°,owF�oFeO S <br /> ��n H _, �ess aon�Feo va�a 5 <br /> �+ �� �aianceo�o 5 ZV _ _ <br /> ��x P,rint or Type Only <br /> C H <br /> 9 H fA <br /> yy H Creekside Custom Homes 10121' Evergreen lday Everett 98204 334-97.i7 _ <br /> z <br /> r� C] Owner Mailing Address , �Ciq� , . Zip Phone <br /> r1:b �� � ' . � � <br /> �, r�i�v-y Aiarlc McKenzie 334-9757 or Brent Baldiain. , 337-8C69 - . <br /> V7 H <br /> � r qpplicant tAailin9 Address Cily Zip Phonc <br /> �^ z <br /> i7 y� •.� <br /> � C��C7 <br /> oescribe P�oposed Work New SFR - 1168sf living / 440sf gar LO� 1- <br /> H b7 O <br /> �]. n <br /> Cy� W <br /> Hy D <br /> I OZZ ' �.. <br /> � �� Projec�Address(i�knownl l � <br /> � �r �Itach lour(4)copies ot plans for proposed work-Draw to scale and note the tollo�ving as appiir,able: �� <br /> � L*1 O Property Lines • Centerline of street ♦^ <br /> 7 y y • Outline and dimensions of all existing and • Indicate North V� <br /> �7 O V1 • Show an ro g 9 9 � <br /> propvsed slrucW res on the lot y p Uosed radin chan es <br /> • Existing and proposed utilities • Show measuremenis /�/� <br /> W <br /> � DO NOT WRITE BELOW THIS LINE o <br /> PERMITCONDITIONS <br /> 1.All calls tor inspection shall be made 24 hrs.in advance-phone 259•8810. �j F; <br /> 2.All work shall be pedonned in accordance with ihis permii and current City of Everett Design and Construction r �� <br /> StanCards and Specilications. <br /> 0�"� 3.Call Localion Underground Service 48 hrs.belore you dig.TOLL FREE NUMBER 1•800•424-5555. � <br /> a .,,�'. <br /> .��m <br /> i����� <br /> �{, t�us i P�c�v� DE q� DF� �i ti�T 1�+� ir.1G S�H�.�S , o <br /> ��-.•�yi . . <br /> � � <br /> . � _/ <br /> � <br /> �_� - a <br /> �:� .� � <br /> �; <br /> r�. <br /> - ' "�' ACKNOWLEDGEMENT OF CONDITIONS <br /> C /ryy The undersi7ned owner.�applicant hereby a9rees to hold and save ha�m� � <br /> � less lhe City ol Even�.tt from any and all claims for Aamages, costs, <br /> �' � ///---111 expenses, or causes o� action Iha� may arise because of inslalla�ion <br /> � �/� u�. . �,_ ' V-�L antl maintenance ot ihe improvement or othPr n9hPo1-way use herelo <br /> � R.��L applied for and lurther ag:ccc to remove same �pon notice Irom Ihe <br /> Approved onstruc on � Date City and to replace p lic pr damaped ihereby. j , <br /> ;� .�'�s�� �/-�� ' <br /> �-� 7 � <br /> FIN SPE N ' Da�e o ��� - � <br /> qpproved as Conslructed Si�nature o Ap liwnt � Da�e � �� <br /> x <br /> WORK AUTHORI2E0 BY 115 RMIT MUST BE STARTED WRHIN I '. .;; <br /> PUBLICWORKSDEPARTMENT 1p0 DAY; OF DATE PER T IS ISSLED AND THEREAFTER IS TO � 0�4.. <br /> �'�.,s_, 3:•00 CedarStreet BE DILIGENTLY PURSUED�OPAP�ETION.THIS PERMR MAY 6E � �p, <br /> �•.",-� Evr,re��,WA98201 � �: <br /> .E` CANCE�LED BY THE GITY UPON ANY STOPPAGE OF WORK ON THIS { <br /> Phone:259�8810 PROJ[CT OV[R 90 OAYS DURATION. � <br /> � <br /> i1' <br />�'1C -S c _ ,� . . .o- f a`f r ' i y^d,.� �l � <br />�'r ��y/� f ^n <br /> l}f"� <br />���.YtlV�����:$- � .u` ut=— . � 4.���-..�a��~� �P �a��'�t—k..£u_:.iTl�a.� 'd.. .:__.a.i e.. �ry . .�...._L� �..1�'�c� �,�. .s <br /> aT'MlO <br />