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7 0 87 � — <br /> Date Publit Wo�hs Pe�mil+ —�� <br /> BItlB�Depl.• � � <br /> Application For <br /> PUBLIC WORKS PERMIT PUOToIaFeeFee S — <br /> 1e34 AppL Fae Paid S ��O�� <br /> Balnnco Due S '� <br /> Print or Type Only <br /> /�(.�„ llP w„r�a.�' > >z� Fvn�etl rl-Je. �8to/ s9-/7.k� <br /> OwnerT' Mailing Address City Zip Phone <br /> _I`�ia/'�!A On /`�Y,(Y�ilnu 7�cSr/n IJ�u �VP A� / ��7� '�✓ 1�-- lOt�'�J C <br /> p�e�� ""���g A dress City Zip Phone <br /> Describe Proposed Work .J�--�—��P/T"<1� �� s1oa� <br /> '-- Z�S.-f.�C c �'U.PB, GiJL� iSkio �f��,-�w/al.c fo.e !��/G�c P�•e,ri•r/C� <br /> ti/U ,.nrNc X � r <br /> r' W <br /> Pro)ect Address(if known) . �'z' ��pm:TT' � <br /> Attach tour(4)conios ot plens for proposed work• Draw to scale and note lhe lollowing as applicable: � <br /> � Properry Lines . • Centerline of street � <br /> • Outline and dimensions of ali existing and • Indicate North <br /> proposed structures on the lol • Show any proposed grading changes <br /> • Existing and proposed utilities S ShoN�measurements M <br /> W <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 1. All calls for inspecti�n shall be made 24 hrs. in advance• phone 259•8815. � <br /> 2. All work shali be performed fn accordance with ihis permit and current City of Everelt Design and Consiruction <br /> Stenc'ards and Specilicaticns. <br /> 3. Call Location Underground Service 48 hra belore you dig.TOLL FREE NUMBER 1•800•424•5555. � <br /> �P�C/CFi�id% /S To �',Por�.oE /�E�'f"D.F'lrJ,9r1/CE O <br /> �suA.c'fJf✓Ty ro.e ST.��,�ET I��.��7cici�iE.c/TJ; <br /> � <br /> � <br /> O <br /> a <br /> ACKNOWLEDGEtiIENT OF CONDITIONS <br /> The i�ndersigne.l owner/epplicent hereby agrees to hold and save harm- <br /> - Icss the Ciry ot Everetl from eny and all claims lor damages, costs, <br /> �` � expenses, or causes of action tha; may arise beceuse of installation <br /> � �� Q �9 �a3 and maintenance ol the improvement or other righPof•way use hereto <br /> �✓�-r rJ 7 applied tor and further agrees to re�aove same upon notico irom the <br /> Approved tor G�o�uctiT �" Date City and to replace pubiic properry Jemaged Ihereby. <br /> ��� � J '�-dJ, �, <br /> FI NSPECTIO �a�e ��'"� � 7 <br /> qpproved as Constructed Sign�at'ure of Applicant Dat <br /> everett PUBLIC WORKS DEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTEP IS TO <br /> � 3200 Cedar St�eet BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> [veretl,WA 9E201 CANCELLED BY THE CITV UPO�ANY STOPPAGE OF WORK ON THIS <br /> Phone: 259�8E�15 PRO.IECT OVER 90 DAYS DURATION. <br />