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<br />�q,�a, � / � � -APPlica�ion For / � � � J���'f� .
<br /> �4 �� N� PUBLI� W�DR�:S �ERMIT Uate_.�J/ lD `��O __ f ,' .
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<br /> � � �/ PUBLIC WORKSDGPAHTfdENT r1�0 Z3I �.f �t'.�..'
<br /> Public Works Permit ri _
<br /> T i , 920�Cedar S!reet �` ��.
<br /> . Everett�JA98201 259��8610 �t-�y" .
<br /> � �� Building Permit k___ ,
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<br />�� f l'fPE 0R PRI�T ON Y �� � s Public Works Fee$�__ __ ,7
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<br /> a{ {; Owner Mailing Ad ees -o City Zip Phone � �,9
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<br /> f�' .Qpplicant MailingAddfess City Zip Phune � i� � {+t�s�yt� I
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<br /> <� De;cribe Proposed Work , �1-L � � �``' �[3'� C�1�s�-C%1't� 'k i 4�k���'
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<br /> „�� PROJECTADDRESS (if known; _. __ _ � ,� �;
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<br /> „r i �� Attach four(4)copies nf plzns for proposed�.vork-Ora�n���s:ale and note the following if applicablE: a��'z��
<br />'� � � •Property Lines •Outline and d.mcn:ior.s of�all exi�.�fng and proposed structure,on the lot •Exi;'��q and proposod�Rilities � � pi i,ry �
<br />����� _ •Centedine of sti_et •Indivate North •Show.:ny proposed grading changes "Show mea.^,uremFnts ' %"
<br /> rh� ����i)O NGT WRITE BELO�V THIS LINE � �'�?i���z
<br /> PERMIT CONDITIONS: `� �1,
<br /> ,��� 1. All c��is foi inspection shail be made 24 hours in advarce - phone 259-8810. im � +
<br /> rr�Tp 2. All work shall be performe� in accordsnce with this permit and current City of Everett Desior� and r� ���rfj., �
<br /> • Constructio ,ndardsand '>pecifications. �� �i'�
<br /> �wti. 3. Cail Location Underqrcun,': 5=rvir,e 48 hrs. before you dig. TOLL PREE NUMBER 1-800-424-5555. ,1 Y�
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<br /> �� �� —'—'"'� ACIWOWLEDG'eMLNT Of CONDITIONS 7I;)
<br /> � � ��� /.'� The und=c;ic�ned owneNapplicent hereby agrees to Y,cld and save harmless -,M
<br /> ,����� � I i� ihe Cit/of_verett trom any and all cleims tor damages, costs,expen�es,or �
<br /> �rnd � �---- causes c'aCioi�that may anse because of installation and maintenance of ��!'�t .
<br /> A proved for C nsbuction Gate � � �� �
<br /> s„y,a, � �, iheimprove,•ientorotherrighi-ot-wayusehr,?toapoliedforandfurtheragrees I�� I
<br /> ` f' � I to remave same upon otice from the C.•:�, ��tl to ieplace public property ��,^-
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<br /> � FINAL INSPECiIGN Dalc ,i{` F
<br /> 4� Approved as Constmcted � � �'�j^�/ �E ,
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<br /> �f .w Signatwe of Applicant D3te , ��FF
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<br />�•��. `� WURK AUTHURIZED BY THIS PERMIT MUST BE STARTED WITHIN 1L0 DAYS O�DlSE FERM1tI�i IS ISSUED AND THEREAF(ER IS TO BE DILIGENTLY P1:9SUF.D TO � :.,;!�
<br />� � COMPLf_TION.THIS FERMIT MAY BE CANCELLE�BY THE CITY UPOIJ ANv�T�iPP• �:'r�OF VJORK ON THIS PGOJECT OVER 90 DAYS DURATION. � m ,f
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