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Date ��l�/x�p "" - <br /> , � PUUIrc KorM�Parmn• y--- <br /> APPlication Far eba oani ._�� 7,�/�/ ,� Q <br /> PUBLIC WORKS PERMIT P�°;o,:Fa.Fea � — <br /> �o��oo<<�a vue S <br /> Print or Type Only 8.�.�=.o�e s <br /> ��r1�0'!Q ?i �01� ���� S� .F+IQI� (.l)/� ��Q'�ZQ'�. <br /> Owner Mailinp Address Cily Zip Plione <br /> ��n�� <br /> Apphcanl Mailing Address Gly Z�p Phone. <br /> De� abe Proposed Work . �,X,�M PA .�liil �%f�__ <br /> P�oject Address(If known) 3�r�fY ��� f/� � <br /> Atlach lour(4)copiee�f D�6 is lor proposed work• Draw lo acale end note tha�ollowing es applicable: � <br /> • Properf�, Linea • Cenlerline ol streel � <br /> • Oulline end dimer�sions of all ealatlng and • Indicale Norih <br /> propoaed structurea on Ihe lot • Show eny proposed grading changes <br /> • Existing and proposed utllilios • Show measuremen�a � <br /> DO NOT WRITE BELOW THI3 LINE <br /> PERMIT CONDITIONS O <br /> �. All calls lo�inspectlon ahall be meAe 24 h�s. in advance� phone 259•$81$. � <br /> 2 Au work ehall be perlormod In accmdance wifh�his permit and current Ci�y ot F.verett Design and Consiruction <br /> Stantlards and SpeCilicatlons. <br /> 3. Call Locatlon Unde�ground Service 4B hrs. belore ycu dig. TOLL FREE NUMBER 1•800•424•5555. � <br /> � ��i��IiiC LcJO�c.�J' PF,c-miT ,f�-"qvi,�E,p �� �/8b O <br /> `- """" � <br /> � <br /> O <br /> a <br /> ACKNOWLEDC� AENTOFCONDITIONS <br /> The undersigned owner/epplicant hereby agrees�o hold and save hf�rm- <br /> less the Cdy of Evereq Irom any and all claims br tl&mnges. cosls, <br /> expenses, or causes ol action ihat may s�nse because o� mslnllation <br /> and maintenance ol Ihe improvement or olher right�obway use hereto <br /> Approved lor Construction — applied for and lurther agrees to remove same upon nolia3 irom Ihe <br /> Date Cily and lo replece public prop�rty damaged fhareby. <br /> FINAL INSPECTION Date <br /> Approved as Constructed Signatwa of Applicant Date <br /> evereu PUBLIC WORKS OEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> � 3200 Cetlar Slreet 100 OAVS OF DATE PERMIT IS ISSUED AND iHEREAFTER IS TO <br /> Everelt,WA 98201 BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAV BE <br /> Phone: 259�BB15 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WOPK ON THIS <br /> PROJECT OVER 90 DAYS DURATION. <br />