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r _ <br /> r <br /> "1 <br /> r <br /> '1 <br /> r <br /> Dnte f S• "At <br /> halip Woraa Parmaa evr <br /> Appliralion For Flits Dept a a s� <br /> PUBLIC WORKS PERMIT NbricWoftFee ��— <br /> Total Fee { <br /> r Lata app[Fie PAM { <br /> Print or Type Only (� 9alaaceD,# <br /> P11 �Qr-i: � � Cia5t Wirc NUL AI.f \�ll � ' ��saa3 C,S�r- Lg4� <br /> Owner Mailing Address City Zip Phone <br /> ker Vie. QCi]X yY"A.liF NI E P�. cap;3 [�S�i - ro8L11 <br /> Applicant pp Mailing Address city Zip Phone <br /> \'C <br /> Describe Proposed Work 1V w. e 5 t C'i P-Nc-e <br /> W <br /> Project Address(If known) 9fol. IxE, L <br /> Attach four(4)copies of plans for proposed work-Draw to scale and note the following as applicable. rr_ <br /> • Property Lines • Centerline of street (A <br /> • Outline and dimensions of all existing and • Indicate North <br /> proposed structures on the lot • Show any proposed grading changes <br /> • Existing and proposed utilities • Show measurements <br /> DO NOT WRITE BELOW THIS LINE <br /> PERMIT CONDITIONS <br /> 1. All calls for Inspection shall be made 24 hire.in advance-phone 259.8815. <br /> 2. All work shall be performed In accordance with this permit and current City of Everelt Design and Construction <br /> Standards and Specifications. <br /> 3. 'Caall Location Underground,Service 48 his.before you dig.TOLL FREE NUMBER 1.800.424.155155. <br /> SJJ,I�I•f <br /> 4, of Kw'� I�Ou�P KSf l'7,tb�IN� a�f.JG ww� ai,�ro.+ \rM,W li u.. <br /> 11 e of 1,4— <br /> If \/��) rPj ea.�..Q �Le ��II <br /> rt„ J)I % 3.3.7 <br /> Si �)p�rNslo., O 1 +47tlrM YT.N �^ <br /> � 1aaf.�,1 i1�'\Aii 6e wr % �i ria �Gr\wICC/ wwY v\w u5�' 6e <br /> INS�eG`I'Pty Yr[Or 4-0t-Owe'ri At <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees to hold and save harm- <br /> fees the ,Cityof of Everett any and all claims for damages. costs, <br /> expenses or causes of action <br /> n that may arise because of Installation <br /> v_ e+3 end maintenance of the Improvement or other right -way use hereto <br /> Z <br /> eAroroved or ConstructionDete applied for and further agrees to remove same upon notice from the <br /> City and to replace bile property damaged thereby. <br /> 1r/9/t33 <br /> FINAL INSPECTION Dale <br /> Approved as Stighature of Applicant Date <br /> everett PUBLIC WORKS DEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST STARTED WITHIN <br /> 3200 Cedar Street 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everett,WA 98201 BE DILIGENTLY PURSUED TO COMPLETION.THIS PERMIT MAY BE <br /> Phone:2598815 CANCELLED BY THE CITY UPON ANYSTOPPAGE OF WORK ON THIS <br /> L PROJECT OVER 90 DAYS DURATION. <br /> S`r`i <br />