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�� <br /> � � <br /> r <br /> I 11/�IH3 PmlicWorksFar�i3 �'� `y 7`/ <br /> Date eiae o�Pi.< � <br /> � qpplication For <br /> � PUBL.IC lNORKS PERMIT PublicWorksFea $ �,. �, ,-, <br /> To�al Fee <br /> LessApo'-FeePaltl $ <br /> J–u, c, �� <br /> Balance Ouo S <br /> Print or Type Only �(�/76 <br /> S. P. Meyer ai15 lOth Street Everett ' <br /> Owner Mailing Address Ciry Zip Phone , <br /> Mel Porrey 7532 Lower ;tidge Road Everett 98203 353-4659 <br /> Applicant Mailing Address City Zip Phone <br /> Constr.uct Car–Port <br /> Desr,ribe Proposed Work _ �— <br /> W <br /> I Prolect Address(if known) _$515 lOth 9t±'K+" K/`Q . � � <br /> �� � <br /> � Attaci�four(4) cupi=s of plans for propo.ed work- Draw to scale and note lhe vllowing as applicable: � � <br /> � Property L'nes • Centsrline of street , <br /> • Outline and dimensions ol all existing and • Indicate North <br /> prop�:aed structu�es on the lot • Show any proposed arading changes <br /> � • Exis;ing and pro'vos^d utilitics a Show measurements — /� <br /> ���. �r W <br /> DO NOT WRITE BELOW THIS LINE /� <br /> P[RMIT CONDITIONS ar�' <br /> 1. All calls for inspection shall 6e made 24 hrs. in advance- phone 259-581 5. � <br /> 2. All work shall be pe,formed in accordance with thi;permit and current Ciry of Everett Design arui Construction <br /> Slandards and Specificaticns. <br /> 3. Call Location Underground Service 46 hrs. �efore you dic�.TOLL FREE NUMBER 1-500•424-5555. � <br /> � <br /> �A <br /> V/ <br /> 0 <br /> � <br /> ACKNOW�EDGEMENT OF CONDITION6 <br /> The undersigned owner/applicanl hereby agrees to tiold and save harm� <br /> less the Ciry of Everett from any a.id all claims for dama�es, costs, <br /> . , � %� �' �% expenses, or causes of action that may arise because of installation <br /> / and maintenance of �he improvement or other right-of-way use hereto <br /> r�f l.f � .. ��/G'� f% <br /> applied tor and further a�rees to remove same upon rotice from the <br /> / <br /> Appro d for struction � Date City and to replace puhlic property damaged thereby. <br /> G� � <br /> � � <br /> FIN INSPEC 10 � ate ate <br /> Approved as Construcled Signal re o ApPlicant <br /> WORK AUTHORIZED BY THI PERMIT MUST BE STARTED N/ITHIN <br /> everett PUBLIC WOR PARTMENT 1g0 DAYS OF DATE PERMIT IS ISSUED AM1:D THEREAFTER IS TO <br /> � 3200 Cedar Streel BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY 8E <br /> Everett.WA 98201 CANCELLED BY 1"HE C'TY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone: 259-if815 PROJEC�OVER 90 DAYS DURATION. <br /> I � <br />