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TYPE OR PRINT ONLY <br />Owner <br />Applicalion For <br />PUBLIC WORKS PERMIT <br />PUBLIC WORKS U[PARTMENT <br />3200 Cedar Street <br />Everett, WA 98201 (425) 257-8810 <br />(�P <br />��3 � <br />Mailing Aodress Ci�y <br />�i ii <br />Appliant " n1ailing Atltlress <br />Describe Proposed Work /� 7rlh v� �'� (� <br />�a�.%r� �'lrh5 �'^✓ hlvv <br />pn ��1�� i�U�� �� ����� <br />�� . / �✓[% jy � �tj .� Li G'1' /^4�cG U <br />PROJEC7 ADDRESS (1 known) ��,�_e� _� � <br />/1 pq � <br />Date _,�' TJ � / I __ <br />Public Works Permit # / � � T <br />Building Permit q <br />Public Works Fee $ 3S� <br />;�, <br />Zip phone <br />y,� 3 3a y-�5s <br />�r2 7 - 33 y-2v6s' <br />Zip Phonc <br />�L. �5/Ur�.f�//v`, � . <br />L � <br />� �tRi o �.� = I <br />�/y, 1 <br />o/J,�,>,,;�„_ �,� �, V�t' s <br />�.r1f�" ���>'� � <br />�—�� <br />,�-��'_� <br />Attach lour (4) copies plan, for pmposed work • Draw to s�le and�lollowing il applicabl¢ ����! �� N/ � JQ w <br />• Property Lines • Outline and dimensions ol all existing and proposed structures on the lot • Existing an �"W�� <br />• Centedine of sireet • Indicate Norih • Show any proposed grading changes • Show measuremenis <br />DO NOT WRITE DELOW THIS LINE <br />PERMiT CONDITIONS: <br />1. All cails ior inspection shall be made 24 hours ir, advance - phone (425) 257-8810 <br />2. All work shall be performed in accordance with this perrnit and current City of Everett Design and <br />Construction Standards and Specitications. <br />3. Call Location Underground Service 48 hrs. before you �i�. TOLL FHEE NUMBER 7-800-424-5555. <br />� CUt7%.0 �o ��. p0/7E' LZ$ .S�c.�f 72%�^�. /�� �i�i B <br />„ � f ��� <br />Cv��L4��� ��sou�s� I�c. ' �ePar «� � 7- a-/ -9d <br />[:L¢nn <br />� �a.�,o ci�y st,,�efs ` af aLL -fi,.,�s <br />C�, /i/n��'Y c.'���y/�L4/%niiJ oL�f t�/�n LrJO/,� /x� ��vn, <br />a <br />_ , <br />_���nf� �4,e�."' <br />FINAL INSPE::TICN <br />Approved as Consvucied <br />�,/z-C?Ci <br />Data <br />� <br />O <br />� <br />V � <br />� <br />a <br />ACNNOVJLEDGE�dENT OF CONDITIONS <br />1'he untlersigned owner/applicant hereby agrees to hold antl save harmless <br />ihe CiC/ ot Everett trom aoy and all claims for damages, costs, expenses, or <br />causes of action that may arise because of installation and maintenance ot ihc <br />improvement or other n�hboi-way use hereto applied for and further agrees lo <br />�emove same uPon notice from the City and to replace public ��roperry dam- <br />_ . �� <br />VJORKAUTFIORIZED BY'1115 PERMfT MUST 6E 57At7'iED!Ni?t ^: 1� DnYS OF DATE PERMRIS ISSUEDANDiHE!iEAF1ER IS TO BE DILIGENTLY WRSUED TO <br />CAMPLEfIpN. THIS PERMfTMAY BE CANCELLED BY THc Cff` `NJ FJJY SiOR'AGE OF W 3?K ONiHIS PROJECTOVER 90 DAYS DURATKKJ. <br />