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Date ��84 <br />ppplication For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />Ron Moran <br />Cox Construct.ion <br />Descrlbe ProDoeed Work <br />1415 75th Street <br />Meiling Address ���y <br />5125 75th Avenue N.E. <br />Melling Addrass ���Y <br />Construct Car–port —_ <br />- <br />tA1S �Srh street <br />PuCI¢WorNPs84�1375z —. <br />Blep Cepl • - — <br />PUEIR Wod� iN f --�—� <br />To,.i �.. <br />L��� �G01 F�a P�iO f--- <br />H�I.nC�OV� � . <br />Everett 98201 347-5230 <br />Zip Phone <br />Marysville 98270 569-1277 <br />Zip Phone <br />gTgygCCO18JF <br />Prolact Addrese (I known) —�------ � - <br />Attech lour (4� copiee ol plenn lor proposed work � Draw lo scale and note � Ce^�1ewine ol sbe�� able. <br />• Proper�y Lines • Indicete North <br />• Outllne and dlmensione of xll ezistlnB end � S�ow p�Y proposed grading changes <br />propoeed stiuc�urea on the lot � Show measuremenls <br />• Exletlnp end p�oposed ulilities <br />..,..�... wmrc aFl OW THIS LINE <br />�ERMI? CONDITIONS <br />1. All calls lor inspeclion shell be mede 24 �rs. in adv&nce � phone 259•B81 5. <br />z, All work shell ha perlormed in eccordence with Ihis peimi. and current Ciry M Ev>rett Design and ConslruUlon <br />Slanderds end Speclflcetlons. <br />3. Cell Locetian Undarg�ound Serv�ce 48 hrs. bAiore you d�q TOLL FREE NUMBER 1•800•424•555 . <br />Dale <br />Approved tor Construttlon <br />Dale <br />FINAL INSPECTION <br />Approved ns Conslructed <br />neverett PUBLIG WORK£ DEPARTMENT <br />1200 Code� Siree� <br />��,,.�♦ I Fvrn.lt. WA 9P701 <br />�J � �,����, : 5U AFl, �. <br />� <br />O <br />� <br />N <br />0 <br />a <br />ACKNOWLEDGEMENT OF CONOITIONS <br />The unAersigned owner/apDlicnnt hereby aBfee9 �o hoW and save harm� <br />less �he Cily o� Everett trom any and ell cleims �or damepes, cosls. <br />expBn585. or ceuSeS o� action �hat m0y BriSO bCCeuSa o� i�6�0118�iOn <br />a�d meintenance ot Ihe lmprcveme�I m othe� righl�obway use hereto <br />aiy�aed o ep ce'publ cgpe0pe1r/yrtlemBBed he�ebyn n�,�ce Irom the <br />— Da�e <br />Signa�we ol Appllcnn� <br />WORK AUTNORIZED BY THIS PERMIT MUST BE STARTEO W�T����� <br />180 OAVS OF DATE P[FiMIT IS ISSU[D AND THEREAFTER IS TO <br />BE DIUGENTLY P'+F7C� V�Up NOMPL 7(IPPn :( IOf�W�Mr nN li�lt�� <br />CANCF:I_LEf�P <br />r�aUt r* <���q�.q °��� I�AvS DURAIION <br />G <br />[� <br />