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Date� z� ��� <br />Apnllcation For <br />PUBLIC WORKS PERMIT <br />�rint or Type Onfy <br />In <br />Mailinq <br />Broa <br />Everet <br />cny^ <br />❑omic wo,xa rpe�rmr . �" `� f � — <br />nina ocv� • /_S �1 <br />r�m¢ wo�w. ��w s <br />Toie� fee <br />�.�-�no� FeePmO a ---- <br />a,�„��. o„� s .2c. E�n <br />%E' 3 5 <br />98Z01 252-1166 <br />� <br />Zip <br />Phone <br />Describe Proposed Work New Single Far�ily Residence _ --- <br />Prolect Address (il hnown) �V� - 7YL """` '"—�—' <br />Attech lour (�1 copies af Plnns lor proposed work - Draw to scalu and note � Ceoterline ol st�ee��oblr- <br />� prope�tY Lines <br />• Outline end dimensions ol all ezisling anA <br />proposed struclures on the lot <br />• Existing and proposed utililias <br />• Indicate North <br />• Show eny ProPosed gradinc� ch2nges <br />• Show maesurements <br />PERMIT CONUITIONS <br />1. All caGs lor inspectlon shnll be made 24 hrs. in advance - phone 259•88 i 5, <br />p, qll wora shalt bo perfom•,ed in ecco�dance wlth this permit end currenl Gry oi Eveielt Design and ConsVuction <br />Stondards and Specifications. <br />3. Call Locetion UndergrounA Service 4N hrc. before you dig. TOL.. FRF.E NUMBER 1•800•424•5555. <br />_f�� �' /�j `-,� <br />l� � <br />FINAL INSPECTION <br />qpproved as Consiructed <br />everett PUBIIC WORKS DEPAf�TME <br />� 3200 Ceder Street <br />Everell. WA 98201 <br />Phone�.259�9815 <br />AGKNOWL[DGfMENT OF CONDITIONS <br />W <br />� <br />�w <br />_ / <br />� <br />� <br />� <br />� <br />O <br />a <br />The undersiyned owner/apPlicant hereby aqrees to hold �nd snvo h;�m�� <br />less Ihe City ol Evere�t trom any and nll cloims lor damaqes, costs, <br />¢xpenses, or causes ol nction Ihet mny arise because ol instellotion <br />J�� and maintenance ol the improvemenl or olher righl�ot�way use hereto <br />applied �or nntl lurther agrees to remove semo upon nolica irom the <br />ite City and to replace public property damaged Ihereby. <br />� <br />.,, �........ <br />dORDAYSTOFRDATD PERMIT ISEISSUED AND THEREAFIER�IiHTO <br />E1E DILIIiENTIV PURSUED TO COMP�_ETION. THIS PERMIT �'AV 9E <br />� ANC[L�[D DY THE CITY UPON ANY S?OPPAGF OF WOHK O� 1H15 <br />P{;nJ[Li OVLR 90 DAYS DURATION <br />z <br />0 <br />.: <br />n <br />m <br />�� <br />1--i �--I <br />V1 2 <br />m <br />co <br />mo <br />-� c <br />O 3 <br />r�� <br />m �' <br />c z <br />a -� <br />rx <br />.. �. <br />-� in <br />< <br />� <br />T � <br />T <br />i*i .- <br />� <br />o� <br />�m <br />C N <br />3 N <br />2 C� <br />-i r <br />. m <br />a <br />� <br />