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Date��"f�(%,�k" 7 <br />A�plication Far <br />PUBLIC WORKS PERMIT <br />Print o� Type Only <br />Mailing <br />c�iy <br />('utll�C \YolAt 1'C�mil • <br />eine o�ni . _ �7� / �4- �/?�— <br />PULI�,;Wmkliae $ <br />,a,a�Fao <br />Less Appl ioa Paltl � <br />Balance Due i <br />pplicant Ma�ling Address City Zip Phone <br />DescribeProPosedWork �y�L �� �Ii,�Y�'Na� � "�- ' i � � �1' �/�- /= /� I�` 1 <br />Proiect Address lil known) /� �d PVV � �v LCl�i. �� <br />Atta^�� tour (41 copies of plans for proposed work • Draw to scale and note the lollowing as applicable: <br />• Property Lines <br />• Outli ie and dimensions of all existing and <br />proposed slructures on lhe lol <br />• Existing and proposed utililies <br />PERNIT CONDITIONS <br />• Cenlerline of streot <br />• Indicate North <br />• Show any proposed grading chenges <br />• Show measurements <br />1. All calls for inspection shall be made 24 hrs. in advancn - phone 259•891 5. <br />2. All work shall be perlormed in accordance with ihis permit and current Ciry ol Everet� Design and Consiruc�ion <br />Standards and Suecifications. <br />3. Czil I_ocation Underground Service 48 hrs. belore you dig. TOLL FHEE NUMBER 1-800•424•5555. <br />B -a7-� � <br />R/r5'L-/C GG�IJf',C�f /�l_-.�'f»/i Nr�T ,(��'�;C,v2�� <br />�A� <br />N/-' rL!� T�) �S� IG �� .c7 �<'.�"�?��r � i?/OCJ / <br />J c�/1. i`=C � �r/il/i, �'�r <br />Approved for Conslruction <br />��r��r �,��i�o�i��G <br />ACKNOWLEDGEMENT �F CONDITIONS <br />W <br />� <br />�w <br />7 � <br />Z <br />0 <br />ihe undersigned owner/applicant heieby agrees to hold and save harm- <br />— less Ihe Cily ol Evcrelt from any end al' claims for Aamages, cosls, <br />expenses, or causes ot action that may nrise because ol installe�ion <br />and mainlenance ol the improvement or other right-ol-wav uso herelo <br />npphed lor and furiher a�rees to remove same upon notice Irom the <br />Da�e Ci�y and to ieplace public property damaged Ihereby. <br />FINAL INSPECTION Date <br />Approved as Conslructed <br />everctt PUBLIC WORKS DEPARTMENT <br />� 32C0 Cedar Street <br />Everelt, WA 98201 <br />Phone: 259-8015 <br />Si9naiurc of �ppliCant <br />WORK AUTHORIZED BY THIS PERMIT MUS? BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PUFSUED TO COMPLETfON. THIS PEHMIT MAY BE <br />CANCELLEG BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />