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�' � <br />D � �e��� <br />Apol�cation For <br />PUBLIC WOFiKS PERMIT <br />Print or Type Only <br />Pub��c wo,�e aermil r ` 7 <br />B�ap DaDf � _ <br />Puo�.c wo�.a:ee s � J/' � <br />,o��ir.. --r�- <br /><< <br />le.: soo� vee M�a S -r <br />Behn:e Ous S ��_-7-'�-- <br />Owner Mail�ng Atldress Gny Z.0 Phone <br />���+-i��� f�/ �`�:�� ,'-�'��„ci 3 2cL ���r �Lrn'in "j�P27Z ��37�c <br />Applicant Mail�n9 Atltlress City Zip Phone <br />/ / J��/-�6a1, r`e�/,�c. <br />L _ . 1 _ � L�.. �., J /' L � ��_, _ / �_ <br />Describe Proposed Work <br />Project Addreas (il known) ����t � T� ��Y��r'« � �' <br />Atlach lour (4) coplee ol plens lor proposed work • Drew lo scale and note the lotlowinq ae epplicable: <br />• Property Llnes <br />• Outline end dimensions of all existing end <br />proposed slructures on the lot <br />• Exislinp and proposed ulilities <br />• Cente�tine ol street <br />• Indicele NoAh <br />• Show eny pro0osed gradinp chenpen <br />• Show meesuremente <br />PERMIT CONDITIONS <br />1. AII calls lor inspectiun shall bc made 24 hrs. in advance • phone 259•881 5. <br />2. All woik shall be perlormed In eccordence with Ihis permlt and current Clty of Everett Design and Construclion <br />Standards end Specilicetions. <br />3. Cell Locetion Underqround Service 4B hra bafore you dip. TOLL FREE NUMBER 1•800•424•55$$. <br />�.� �� �-�D ����o / ' �:� // `"3 <br />/ <br />� ' ��-rG. <br />Go►�,�A�Z w�u. s�- ctAsr�1� or-� ��� �� <br />(, i (�a�� �r- F�r` a <br />�C� --rt-IE ►JfsEssdal�y� <br />yo�cz t�u�,�� w�� <br />, <br />I//7 �,.�� /;t...� , .. . <br />� <br />PINAL INSPECitON <br />ApproveA as Constructed <br />pyp�p(� PUBUC Y'ORKS DEPAFTMENT <br />I � .,:'0' Cnnn• 5;��^. <br />i�... . �.:. o�. � <br />-r� n,�� ,-T�if. 4� �,.)� u- �F UTi�.a ��S <br />-rQ.A�Gp� c. con17�� . t,�.b2�, u�/77� <br />� U�rS �UE�. ^��1 � n�Gy io/ii�f33, <br />Date <br />W <br />H <br />� <br />� <br />� <br />C <br />� <br />I <br />• <br />♦�♦ <br />V/ <br />C <br />a <br />l� , <br />ACKNOWL E NT OF CO DITIONS <br />The undersigned owner/ep � �� he�eby egree to hold and save harm <br />less the City ol Everetl Irom any and ell claim for damages, costs <br />e■penses, o� causes ol ection thal may ense because ol metellnt�or <br />and maintenence of Ihe imDrovement or o��er righbol�wBy use he�cl� <br />epplied lor entl �urihe� Bprees to �emOve Same UOon no�ice Irom Ih� <br />City and lo replace pubhc property damaged t�ereDy. <br />�.L'/ ,- c�-� /.�� � /� �� <br />Signature ol Apphcant � Dale <br />WORH AUTHORI:ED BV THI$iP.EHMIT MUST BE STARTED WITHI� <br />tP0 DAVS OF DaTE PEPAnS �5 ISSUED AND iNER[A�TER IS TC <br />i TO A�p; TI�": THIp, orql��i.1 A1a• P.i <br />EE ^iUGENTL` �1.R5;1E: CO E <br />. ..... , . '.. . . . , . . � _. , �•,. - , . . <br />