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I 1G <br /> 1 <br /> '�f � <br /> Y <br /> , � <br /> � / ``+�- � <br /> 7 <br /> ���� �I <br /> nBfB���1) �.� ' P�oiicworesi-rrmn> ;At� � <br /> Application For -" 91,:`� 00"�.+--. .— i <br /> PU�LI� W�RKS PERI�IiT PubTOL FceFea s��` <br /> 0 Less ApOL Fee Pa tl S___,_ _ <br /> Print or Type Only � � S aa�,��ac�e S_ � <br /> CJ �7 �t I <br /> N If7 In <br /> M Y! <br /> .r�/ <br /> �i/ ..� I <br /> ��¢l� �C,j ��a�c� �s,�s 2 �� 7 3s�� �'oc7PF o/T q,fZ� l Zs'�q 5��� � <br /> Owne. Mai!ing Address m o �`,K� Lp � Phone � <br /> / / m sor'� <br /> !-["Cc �S �u/I/S/r 't<�r{(. '� � l' — / — � -- ` <br /> Applicant Mailing Address Chy Zip Phone � <br /> Describe Proposed Work ��/ // � C/�� 1�5+/� �i�.�_ II <br /> — — - � I <br /> ProleclAddresslif known) ._!- yb / > �'��!'� � / �L�,SL . _ _ (� '�. <br /> r <br /> �\ttach four(4) copies of plans lor proposed work- Draw�o scale and note the�ollowing as applicable: � <br /> • Property Lines O Centerline of sireet �^ I <br /> • Outline and dimensions of all axisting and • Indicale North �� �. <br /> praposed sirucWres on ihe lot • Shu�:•�n!•propostd gradinc� changes <br /> • Existing and proposed utilities • Sho�v measuremenls � , <br /> DO NOT WFITE BELOW ThIiS LINE � i <br /> I <br /> PERM;T CONDITIONS <br /> 1.All calis for inspection shall be made 24 hrc,in advance-phone 259-8810. � ; <br /> 2.All work shall be performed in accordance wi;h tnis permit and current City of Everelt Desi9n an9 Construction � <br /> Standards and Specifications. � <br /> 3.Call Locatlon Underground Service 48 hrs.betore you dig.TOLL FREF.NUMBER 1•800•424-5555. 'c.� � <br /> �_ /�'rcis.c�r► lGJ?7�'� ( r.r �'�IZ "� cc�� `' I� <br /> � ,/ �''%? � �I <br /> S: s�c� �,'�� �%'� � �, I <br /> � <br /> � <br /> � <br /> a <br /> i <br /> ACKNOWLEDG[F,i;_P1T �..`f GONC)ITIONS � �� <br /> 1�e under;igned owneriapPli._.;n� ��r� c,�i 39rees to holG and save harr-,� � qqq�� <br /> � —�%-"--- --- icss tl��e: pdy of Everelt irorr arry :�•id a" daims for damages. costs, i � <br /> •�/� exper�ses. or causes of actien Ihat may arise because of installation <br /> //'' i � k <br /> �i,7� /�� � � �y_�j�� and ma;�tenance ot f�.e ��provemert or olher �ight-of-;vay we herelo � <br /> _��� ,.��1l,� � �� � applied lo ahd turther a regs to �Pmove same upon notice Irom the I <br /> Approved tor Const cGon �, Date City and.�(eplace oubl� y perty damage �thereby. <br /> -, �� � � <br /> FINAL INSPECTION Da:e �1 ' � '� '� � I <br />' Approved as ConsVucted S- trdtiTre of App�� � Dale <br /> everelt PUdLIC WORKS DEP4RTMEN7 �GJORK AUTHOR26D BY THIS PERMIT MUST BE STARTED WITHIN I <br /> .' 1B0 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO I <br /> � 3200CedarStrFet ' BE DILIGENTLY PURSUED TO COAIPLETION. THIS PERMIT MAY B[ <br /> Everett,WA 98201 CANCELLED BY THE CITY UPON�NY STOPPAGE OF WOFK ON THIS <br /> Phonc�. 259-P810 PROJECT OVER 40 DAYS DUR�TION. <br />