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� <br />� <br />• ���, � <br />PUBLIC WORl�S PERMIT <br />PUBLJC �NOAKS DEPAHTMENT <br />3200 Cedar Syreet <br />Everett, WA98201 259-881C <br />Sw IiG�,s <br />TYPE OR PRINT ONLY <br />Noaw�L' <br />ow�,e� <br />�� 1 , 1�� <br />Applicani <br />Describe Proposed Work <br />Mailing Address <br />iI V <br />Ciry <br />C!ty <br />�� <br />PROJECT ADDRESS (if known) �Q�'YI � 4� � lh ' 1q� ���N,N( <br />Attach four (a) coples of plans for proposed work - Draw to scale and note the tollowing if appliwble: <br />�fa��'��� ,.? /9� 73' � <br />PubliC NbAq i.Y..m�t �I _ -/ o Q 8 <br />Bu�lding Pnr;.t a <br />Public Works Fee E O�� <br />Phone <br />mone <br />•Froperty Lines 'Outiine and dimensions of all ezisting and proposed structures on tha lot �Existing and proposr,d uHlitles <br />'Centcrline of street 'Indicate North 'Show any proposed grading changes '31iow measurements <br />ar-- <br />PERMIT CONDITIONS: <br />1. All calls for inspection shall be made 24 hours in advance - phone 259-8810. <br />2. Ali work shall be pertormed in accordance with this permit ar�d current Cih of Everett Design and <br />Construction Standards and Specifications. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800-424-5665. <br />4, �en-,o!/s�L oF S�/�s%� P/LE D/t�L� <br />�Jo F � e_.�= (�, c L��t-2l �V (� a�D C� �3 ���i <br />U ��n � o,�.s�y�v /3y P,��l�t/>.t/�j . . <br />oa-ia-ve. <br />N <br />J�L� ,J'�11F�— �C�ovEl� �^To�a� <br />t S-4 —o �J t�ip' <br />. C22�'r� <br />96G�o <br />�c.oc <br />�o.co <br />;t O�f53:6 <br />L�?�Li\ �V.LV <br />— - ACKkOWLEDGEMENTOFCONDlTIONS <br />�-' The underslgned ownedapplicant h <br />�J erehy agreea to hold and snve hartnless <br />/� the City ot Everett fran eny and all clakns for damages, costs, expenses, a <br />App ed for� ion Date causes of actlon tAet may arise because o} instatlatbn and m�intenance of <br />/� the Improvement orother rlgM-of-wny use hereto applied 1or and hxther apreee <br />to remove same upon nutice fiom the City and to replace pubYc propMy <br />dama y. <br />fINAL INSPECTION Date � <br />Approved as Corstructed C� � <br />of Applbant p� <br />WORK AUTHORIZED 8Y THIS PERMIT MUST BE STARTED WITi1N 180 DAYS OF DATE PERMR IS ISSUED AND iHEREAfTEq IS 70 BE DILIOENTLY pUFiSUEp TO <br />COMPLETION. THIS PERMIT MAY BE CANCELLED BY THE CITY UPON ANY STOPPAGE OF WOqI( pN 7HIS pqpJECT pyEq gp pAYS DURAi10N. <br />