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TYPE OR PRINT ONLY <br />Applkatlon Fc • <br />PUBLIC WORKS PERMIT <br />PUBLIC WORKS DEPARTMENT <br />3200 C9d8i utr96t <br />Everett, WA 98201 (425) 257-8810 <br />Date G�''`�7 �°� ��f`�Q /\ <br />Public Works Permit M 3 <br />Building Per�nit k <br />Publ(c Works Fee a '�� 00 <br />G1 i He�af� /33o S-6'" ST Sa t,,���tt (,,� q8Zo3 �Nzs�yo-►-o2oZ <br />Malling Addreas Ciry Zip phpne <br />� ✓14C� fl� � � . � � � t � <br />Describe Proposed Work <br />��d�H ba-h}o�++Pa.�Q�cP��vew�y �Ste a*�,<<.�� <br />Skc,kf�� oa r; q�,+- S id�c e� e�� � v-e wQy . f:�. ftMd f/a � pa�� o� c„+L <br />Sd CarL�I+S NO�F �jJ a�O�N tu�fe �:�l.M ba�k,�Joufiv�° drrv�t,.�a�, <br />PROJECT ADDRESS (if known) ( 3 3 0 -S(� �" ST f W E✓4!� '�.� (,�/�j �,d ZO,� <br />Attech four (4) copies plana (or proposed work - Draw to scale and note the tollowing If app�icable: <br />• Property Unes • Outline and dimensions of all ezisUng and proposed strudures on the lot • Ezisting and proposed utilities <br />• Centerline of atreet • IndMate North • Show any propoaed grading changes • Show measuremenh <br />DO NOT WRITE BELOW THIS LINE <br />PERMIT CONDITIONS: <br />1. All calls for inspection shall be made 24 hours in advance - phone (425) 257-8810 <br />2. All work shall be performed in accordance with this permit and current Ciry of Everett Design and <br />Construction Standards and Specitications. . <br />3. Ca0 Locatian Underground Service 48 hrs. be(ore you dig. TOLL FREE NUMBER 7-800-424•5555. <br />� �j%s P��r.•,i1` %t �.s.tvcd wiySli Cotis�oder4�ion �iQf �lie <br />h�v„e aw.,¢r..� Qs.soc.4�:on ii4s 6�en Con�cc�zd �n� <br />a��''ee.S iw"r!h qLCnwiny �.,r, t�ineeat� yo w%o�r� �l,e <br />p�/^ivec✓a� 4� �:s Loca�ioh. <br />�� p,,,�'iS�/nf CU/^6 /S h0 f�0 6e <br />CUr6 �'y'vt`l�-�' �'''i�is� con,Pl¢!c�% <br />FINAL INSPECTION <br />Approved as Constructed <br />_ yQ <br />Date <br />kr,ac.E¢�o�'t�'. %/Te <br />/'erno✓e�� �-d r's�ola�ed <br />W <br />� <br />� <br />ACKNOWLEDGEMENT OF CONDITIONS � <br />/ The undersigned owner/applkant hereby aprees to hoW and seve hartnless <br />99 the City of Everett from any arM all cleims for demagea, cosb, expermes, or <br />causes of ectlon thet may erise because of InstellaUon and maintenence of Me <br />improvement or otlier right�of-wey use hereb applied for arM turtlier agrees ro <br />�v�eesame upon nclke trom the Gry and b replace publk ProPertY dam• <br />>^ '4�! <br />,�� � � � � ��' ��e�— <br />WC')RKAUIIiOF�D BY 7HIS PEHMR MUST BE STAfi�ED NRTHKJ 1B0 DAYS OF DATE PEFiMi IS ISSUEDMD 7FEF�AFIER ISiO BE 011OENTLV PURSUED TO <br />ppNpLETpN.7}NS PEFMIT MAY BE G4NCEIIFD BY711E CRY UPON ANY SIOPPAGE OF WOFiC ON iHS PRO�EC� OVEFi 90 DAYS WRAiION. <br />