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Date`�"-'- <br />Application For <br />PUh3LIC WrJRKS PERMIT <br />Print or Type Only <br />%�I(C�.S <br />Applicant <br />Describe Proposed Work <br />��L ,SC' C=Cc? <br />Mailing Aatlress <br />Muilina Address <br />NST1�« ,35 � /ti'� <br />� Lt�7�-r� <br />Ci1y Z�P <br />�Y is' <br />r��n��� wo�.s re����� /./ <br />Biae Dent � �L O ` --. <br />r�o���woasvee S 7�p, (90 _ <br />rmai F„o <br />�.,,.oa�..aF., a -- <br />s 'j.0. tU O <br />n�i.��� o�� _ _ <br />Project Address (il known) <br />So 9 7s � F✓ �. w co� •r� <<f <br />Attech lour (4) copies ol plans lor proposed worh- Dru.•: 10 scale and note� Ceniterline of sl eet A1i1�: <br />• Property �.ines • Indicate No�Oi <br />• Oulline nnd dimensions of all exisling and � Show any proposed grading changes <br />pioposed etructures On the lot � Show me3suromenls <br />• Exlsling and proposed u�ilities <br />(7635 <br />�ss yy�z- _ <br />Phone <br />PERMIT CONDITIONS <br />1, All calls for inspection shall be made 24 h�s. in ndvance - phone 2b9•88� 5. <br />2. All work shell be perlormed m rccordance wilh Ihis permil nnd curren� Ci�y ol Everelt Design end Oonslruction <br />Standerds and Specificalions <br />3 Cnll Location Underground dervice 48 hrs belor� you dig, TOLL FR�E NUMBER 1•BOO.O20•rJ5S5. <br />3-�- <br />Cpnslr �tlion <br />�♦ <br />FINAL INSPECIIUrv 1 � \ <br />Approved es Consirucled v <br />r•vrroll PUBUC WORKS DEPARTMENT <br />� 3200 Cedar Slree� <br />Cveret�. WA 98201 <br />PhonA:259-8815 <br />� <br />� <br />� <br />� <br />O <br />� <br />ACHNOWL[DfLM[NT OF GOt1DITION� <br />The undcrsic�ned ownedaf`P��cant hereby agrees to hold anA save harm� <br />'I less Ihe Clty ol Everett Ir:m any nnd all claims lor damages. �:osts, <br />I..•xpenses. or causes of ac��on that may arise because of installation <br />��nd maintanance ol ihe Iniprovemenl or othor nphPobwey cse hereto <br />�piiied lor nnd lur�her ag�ees lo remove snrce upon notice irom thu <br />City nnd1QJ iePlace pu ic proparly damaged Ihereby. <br />(/�� ... `^ �� �` ' c '_ <br />� / (�k <br />Si9n�re nl ApPlica Dale <br />A�DAYSTOFRDATD PEI7MIT ISEISSUED �ND TH[RLA TER ISFTO <br />BE DILIGENTLY PURSUED TO COMPL[TION. THIS PERMIT MAV BE <br />CANCELL[D �'I THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PPOJECT (1V[R 90 DAYS [JUIiATION. <br />