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f <br />� <br /> I <br /> l <br /> I <br /> i <br /> I :JJG i�C L <br /> ���6i� ��� � <br /> � � �Y �Y 7 <br /> Date � �� � PuElic Workn Permil� -- <br /> eieo.oou�.• �� <br /> Application For <br /> PU�L.IC WORKS PERMIT P°°ToaFeeFee s � oD <br /> lesn Aoo�Fao Paid S <br /> "yo. oa <br /> Balanca Duo S_ <br /> Print or Type Unly ����� <br /> l ,���.�'',�rs��P ��.����' �`'�n� ��_�-��%i�. <br /> �LYf1ef Mailing Fddrass C�ty Zip Phone <br /> �r�/1fC -- -- - --- <br /> Apolicant Malling Address Gty Zip Phone zo <br /> . � <br /> DescribeProposedwork �/�Q � Sl��/���� /�� f� %�/�P�A� � <br /> m <br /> .-� .. <br /> --.... -.{ � <br /> ��- -__ •-• -� <br /> - — _ _ --- _� `n rn <br /> 3a s a. — ,4�,�). � o <br /> Project Addrees(if nown) _ e o <br /> mo <br /> n <br /> Attach four(4)copFeS_of plans ior proposed work• Draw to scale and note�he�tollowing as applicable: 6� p m <br /> • Pwperty' ines - - --.-_. • Centerline of sireet ♦� � z <br /> • Oullina and dimensions of all existing and • Indicate North V J = "'� <br /> proposed structures on the lot • Show any proposed grading changes m .• <br /> 9 Existing and proposed utilities • Show mea�uremen(s /yy p Z <br /> W c <br /> � _ <br /> DO NOT WRITE BELOW THIS LINE O �N <br /> PERMIT CONDITIONS p � <br /> t. All calls for inspection shall 6e mzde 24 hrs. in advanca- phone 259-881 5. ^ T� ? <br /> 2, All w�ork shell be oerformed in accordance with this permit and current City ol Everelt Design and Conslructian ♦ .--i r� <br /> Standards and Spedfications. _ <br /> m �- <br /> 3. Cali Lccation Under9round Service 4B his. belore you dig.TCLL FREE NUMBER 1•800•424•5555. �y o ✓� <br /> G � m <br /> o c cn <br /> 3 � <br /> m <br /> z c': <br /> -i r <br /> . m <br />� � a <br />� A <br /> 'I � <br /> 2� <br /> � <br /> � �1 <br /> r <br /> � ' <br /> C <br /> --1 <br /> _ � <br /> C% <br /> r <br /> ACKNOWLEDGEMENT OF CONDII'IONS <br /> The undersic�ned owner/applicant hereby a9rees to hold and save harm� <br /> — �!/ less the Ci�y ot Everett irom any and all claims for damages, costs, <br /> `� //���� expenses, or cuuses of action Ihat may arise because ol mstallation <br /> `�j� and maintenance o( he imprcvement or other rif�ht•obway u�e hereto <br /> lietl for and tu er agrees to remove same upon notice from the <br /> Approved for Construction � �a�e Cit and to re lac pubf perry damaged ther k�y. <br /> / <br /> � G, <br /> - z-a a-� � l� ����� <br /> AL I SPECTIOIJ Date <br /> Approved as Conslructed i nature I Applicant <br /> ORK AUTHORIZED BY THIS PERMIT MUST �E STARTED WITHIN <br /> everett PUBLIC WORKS DEPARTMENT 80 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200 Cedar Slreet BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIi M11AY �E <br /> Everetl,WA 98201 CANCELLE� BY THE CITY UPON ANY STOPPAGE OF WORK Otd 11115 <br /> Phonc: 259�8015 PROJ[CT OV[P 5Ci DnVS DUF7ATIUN. <br />