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oatel�LY�PS <br />A!!G��aP�ioryfor <br />PUBLIC W!�RKS �PERh91T <br />Print or Typs Only <br />�� <br />Jwner <br />Vubec Wnrxe Permil • ��' / 1 <br />BiUy D1n1 • � _Y _ <br />Pueim Work� Fn <br />Talii Fee � -- <br />Lnee Appl iaa Pei� R <br />Bn�a.�roDue � <br />G Q n � <br />�3� %7 .'��'� ��n.�.s <br />__�drn� <br />Applicent MIef�lingAddresa City Zip Phone <br />�//,^'�( / �',` GfI�� <br />Daecrlbe Pr000eed Work _�� � . _ . __ <br />�� <br />Pro�acl Addreee (11 known) - <br />Pl�ech lour 14) coplea ol plens lor proUoeed work � Draw to scele end note Ihe following as applicnble�. <br />• Property Linea • Cenlerline ol streel <br />• Oulline and dlmeneions ol ell exisHng end • Indir,ete Ptorth <br />proposed elrueluras on Ihe lot • Show any oiopnsnd greding chpngee, <br />• EMletinq Bntl propoaed Utlliflee • Show mexs��ements <br />PERMIT CONDITIONS <br />i. All celle for Inspeclion shell be m�de 24 hrs. in ddvance � phone 259-8815 <br />7. All work 9hell be pPrlormed in acrordenGe Wi�h IhB permit entl current City ol Everell Devgn and Construc�inn <br />Sfantlerds enJ Snacificationa. <br />3 Coll Location Underprnund Service 48 tire. belore you dig. TOLL FREE NUMBER 1•800•424•5555. <br />4. My gradinq of thie lot is to be done so as not to impect the adjoining lote <br />wfth rain-water run-off. <br />5. Si.dewalk ie new and unbroken. My demage to it will requ.ire replacem9nt by <br />the npplicant. <br />Haul organic material (brLeh, etumpe, trees, etc.) off lot. <br />G� � • _ <br />� � <br />�� (� GI,GQG�' �r�cxl.��� <br />�i$EL <br />` ��� S � � <br />/o0`i ro�i ,, <br />_ G, _ _. y's <br />C �te <br />� 3-S - �7. <br />oaie <br />Approved ae Constnic�etl v V <br />everett pUBLIC WORY.S DEPARTMENT <br />� :'200 Cetler Stree� <br />Everett, WA 98201 <br />Phr�e.259-9dt5 <br />r � <br />W <br />F- <br />� <br />� <br />LJ <br />FCKNOWLEOOEMENT OF CONDITIONS <br />1 h�:r unde��in �rd owne�/ �ppl�ceN he�eby Pgraes lo hold n�A snve harm� <br />h^�5 I�`P Gtlp OI Evri1,11 �fOAI 9OY B9, B�� C�BIRIS 10� '.�flrt�39P9, f,pA15. <br />eKn••��s^s, or cnu�es ol ectmn Ihat mxy erise beceuse o� inst Jl;�tion <br />a�d m nnlene�ce ol �he improvemen� o� o�her ripht�ol�wey use h��relo <br />appGed fo� anA �urthei agree9 to remova eamn upon notic� hori Ihe <br />City and lo replece Oublic pwuerly damaged Ihereby <br />Sig�ature ol Applicanl Da�e <br />WORK AUTHORI2ED BY THIS PERMIT MUST BE S7AR'ED WITHIN <br />1B0 DA'/S 'JF DATE PERMIT IS ISSUED �ND THEFIEAFTE!i IS TO <br />BE DILIfiENTLV PURSUED TO COMPLETInN. THIS F�ERMIT I,IAV 8E <br />CANCF_LLED bY THE CI1V UPC%N ANV STOPPAGE OF WORh:ON THIg <br />PROJ[GT OVEN o0 DAVS DURAT�ON. <br />