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Date u�+l�� <br />qpphc,�tion Fo� <br />PUBLIC 9NORKS PERMIT <br />Print or Type Only <br />Mading Atldress City <br />�s /laDz Nnun Yi �'1UC <br />Maihng Address ���1' <br />-�.�. . _ �, ,: ; � n nlo. rL <br />Describe Proposed Work <br />z�n <br />Prolect Address lil known) <br />Atlach lour 14) coPies of plans lor proposr.d work � Oraw to scale and nole Ihe lollowin� as apGlicable: <br />• Property Lines <br />• OuUine and dimensions of all exls�ing and <br />proposetl strucWres on the lot <br />• Ezisting and proposed utili�ies <br />Put�brWorxsPermJ. _SLL7' /l�L___.'_'/ <br />F, �,� oeo� . _� `l�-�l_4.�3 --- _ . <br />6,�e��� ww�s n �--------- ------ <br />,��a�«. sG_ - <br />Le5SA1�Ul iPP PI�U J! � <br />�1All�� �� nul• J �� <br />z <br />• Centerline ol sireet <br />• Indicate North <br />• Show any proposed grading changes <br />• Show measurement� <br />PERMIT CONDITIONS <br />1. All cells lor Inspeclion shell be made 24 hrs. in advance • phone 259•8810. <br />2. AI� work shell be performed in accordence with this permit and curreni City of Everet� Pesign and Construction <br />Standerds end SOecilicatlons. � �555. <br />3. Call Localion Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1•800•4�.•� <br />� <br />y�-<��, ��,�,�� t, �� ��,>t�,��v ��><<.Y::.. :��,��:..��.� <br />, ,�-:�Y <br />'everell PUBLICWORKSDEPARTMENT <br />� 3200 Cedar Street <br />Everelt. WA 98201 <br />Phone: 259�b810 <br />osiisie9 i:�sen <br />i <br />W <br />H <br />� <br />� <br />� <br />u <br />H� <br />� <br />H00021583 O <br />PLDG 425^c.DO <br />B SRCH 43.50 � <br />H00020910 <br />DFT.?0 f27.� <br />FW PC t7.�4 <br />FWINSP 84 <br />ACKNOWLEDG�EHb 0��8�ONS <br />The undersigned owne�/applic$}��eby�q� I�hold antl seve harm� <br />less Ihe City ol Everel� Irom any and alrcfaims lor damages, costs, <br />ezpenses. or causes of action ihal rr•ay arise becauee ot installation <br />and maintenance ol ihe improvement or o�her righl•ol•way use herelo <br />applicd lor and lurther a�rees lo �emove same upon notice irom �he <br />Gty and �o replace public properry damaged thereby. <br />�% <br />„_ . � /ii' ..�, Al� ) � - �s- �% <br />S� nature ol pphcant Date <br />WORK AUiHORIZED BY THIS PERMIT MUST �E STARTED WITHIN <br />100 DAVS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />GANCELLED BY THE CITV UPON ANY STOPPAGE OF WORK ON THIS <br />PROJEC7 OVER 90 DAVS DURATION. <br />