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_ ._,.� <br /> � f, � V11012 WOrFf V91T�1• J��__� � li <br /> H � Date ("� � <br /> Omq.Dept + I <br /> � App'�jation For � <br /> � � PUBLIC W(�RKS PERMIT °°°°°w°��,feB S z�isz — ' <br /> Q ,o�a���� <br /> ��� �p Less aooi.F±e Paia S�� I I <br /> r7 O � � � F � �Baiance0ue $ ��/`rZ— <br /> f! O Print or Type Only � 'r' (Q'Z� <br /> � ��q9g�S��NG� �� <br /> p� p v"�i a ��� N �„^ a;��.;�le, WA. 98027 481-2401 <br /> •b�'� COASTAi. PACIFZC DEVELAPt1E�T� IN�• <br /> � i � � n i 7 � 1 p_��.,`�r,-�`4�, '—�:-_;,�;R���,�,ti= �x-�—=�-�'=�..� <br /> �p Owner �lal1�o4�c�i�r� N � City Z P Phone <br /> .. r= w <br /> �� \ O !~i 3 � G- 2 <br /> CQ SRiYIC •• xoa. n. or� <br /> 4N• O qpplicant Mailing Addresc City ZiP ?hone <br /> xy� <br /> `' Descnbe Proposed Wark �d� ((t1� � GDLi r�rxP.�7� rmm�IP_.X_—�'fh IfVF �A)P� I <br /> � � <br /> ��° SF�A- 6n S9 — <br /> ���� � <br /> � �h ,_ � <br /> •.- r Project Address lif knownl 87��' — S— Ac ,c �c/ <br /> Altach lour(4)copies o�Plans lor proposr.d work-Oraw to scale and note the tollowing as applicahle: � � j <br /> • Property Lines • Centerline of streel � � � <br /> • Omline and dimensions ol all e.xisting and • Indiwte Nonh <br /> pr000setl slrucWres on the lot • Show any proposed gratling changes <br /> • Existing and proposed utilities • Shuw measurements M <br /> : . DO NOT WRITE BELOW THIS LINE O I <br /> .,--� ��.\ PERMITCONOITIONS � <br /> 1.All calls lor inspection shall be matle 24 hrs.in advance•phone 259•8810. <br /> � C�� 2.All work shall 6e peAormed in accordance with this permil and currem City ol Evereti Gesign and Const•uction , <br /> � Standatds and Speciticatiuns. I <br /> 1 j 3.Call Lowtion Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1•S00•4Z4-5b5S. � <br /> ; �--� �, ,� �,pro��jo�S 4Q� 9 -�s-�� O ' <br /> ' � r <br /> I �! � I <br /> i � <br /> I`��' <br /> � ' <br /> .� 1 a , <br /> � <br /> ; � ... � <br /> �I�I ACKNOWLEDGEMENT Of CONDITIONS I <br /> � The undersigned owner/applicanl hereby agrees to hold and save harm� <br /> Iless the Clry of Everett from any and all claims for damages, costs. I <br /> � � ' exp�:nses. or causes ol action that may arise because of installa[ion <br /> _+ maintenance ol the improvement or other rigYa�ol�way use hereto <br /> appi ed for and �urther ees to remove same upon notice trom Ihe <br /> � - App ved lor Con uction e City and to replace p lic roperty dama9ed ihereby. <br /> 1 O <br /> ' � � � -$ - � � 't'a�l1.c� l_�� <br /> FINAL INSPECTION� I � Date / Dale <br /> Approved as ConslruCted Si nature ol APPlicant <br /> W RK AUTHOPIZED BY THIS PERMIT MUST E�`c S7ART WITHIN <br /> e�� PUBLICWORKSDEPAFTMENf 1 0 DAYS OF DATE PERMIT IS ISSUED AND TFiEREAFTER IS TO . <br /> 9'LOOCeGxrStreel g DIUGENTLY PUFSUED 70 COMPLETION.THIS PERMIT MAV BF. I <br /> Everett WA 9920i CANCELLED BY THE GTY UPON ANY STOPPAGE OF WORK ON THIS / <br /> P1�nne�259•98t0 � �QqJEC'OVFP 40 Da�S DUF7aTION. <br /> i <br /> 1' <br /> i ' <br />