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Applkadon Fw D8f6 (0 �—/ I <br /> PUBLIC WORKS PERMIT pubifc Works Permit N ��,� <br /> PUBLIC VVORKS DEPARTMENT <br /> 3200 Cedar Street <br /> Everett, WA 98201 (425)257-8810 Building Permit k <br /> TYPE OR PRINT ONLY TO POSTIN6 JAN 0 4 2001 Public Works Fee S ,�J.S�S � <br /> ��,�.�- l'�r<i��,,� C'li••.•� l. /,�iv Eo�srSw A` �B2v3 <br /> Owner Malling Address Ciry Zip Phone <br /> ,�'�.�.c_ <br /> Applicant Mailing Address City 7Jp Phone <br /> Describe Proposed Work �TlTf'v!'► r dr i cL W <br /> 1104 �l/�f � � <br /> V♦ <br /> PROJECTADDRESS (if known) _ � W <br /> Attach four(4)copies plans for proposed wo�K-Draw to scale and note the tollowing If epplicable: O <br /> •Property Unes •Outline and dimensions of all ezisting and propnsed structures on the lot •EzisNng and propos�d utilities ' <br /> •Centerline of street •Indicate North •Show any proposed gradi..g changes •Show measurements <br /> DO 1JOT WRITE BELOW THIS LINE Z <br /> PERMIT CONDITIONS: O <br /> 1. All calls for inspection shali be made 24 hours in advance - phone (425) 257-8810 <br /> 2. All work shall be performed in accordance with this permit and current City of Everett Design and ■ <br /> Construction Standards and Specifications., r <br /> 3. Call Location Underground Service 48 hrs. before you dig. TaLL FNEE NUMBEH 1-800�424-5555. ♦/� <br /> \/�� <br /> � ,�.�,, o���� l�s ��e� �s=3� -'9� -� :i:_ : a <br /> ta:.� a;- <br /> _= ;�;^" _ <br /> .:.:;c-..;: <br /> . :-r_c_. _ _ <br /> ACKNOWLEDOEMENTOF^ANDRIONS <br /> The undersigned owner/applMant he�eby ayreea 4�hold and save hermlesa <br /> �' the Gry of Everett from my end all claims for dameges.cosb,ezpeneea,or <br /> p r ons on a aeuses o(actlon thet mey edse becauae of installatk,n and mek�tenence ol the <br /> � U improvement or oU�er dqhtof•way uee Mreto applled for and fi:rther egrees ro <br /> � .:/� 71 Zci.G� re ed tlresemB 1m�n ihe Gty snd�o repince pudk pmps�ty dBm. <br /> � Y <br /> FINAL INSPECTION Date � � q <br /> Approved as ConsVucled � <br /> u ican e <br /> woFacnunaa�oevnisawnnrruiusreesra�vurn�ieoonvsoFnn�aew*r�s�unw slueeo�x�ert�v�nro <br /> OJ�LET10N.7HS PEiiMfT MAY B�CANCELLED 9Yil#CffY UPON ANV SNPPAOE Of WOF1(ON 1H6 PA0.ECT WEti BOOAYS OUFNlqPI <br />