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Date� — 90 <br />Application For <br />PUBLIC WORKS <br />Print or Type Only <br />a <br />�ERMIT <br />� <br />r u g <br />c°7 o ci <br />.r ra ri <br />r.� <br />� a <br />� �� <br />J <br />,�k' � r ^ � C��y <br />0 <br />� W <br />m � V <br />% � <br />r�.nur. wo,.e v,.imn . . �O �3y0 <br />oiep oeoi • <br />r�m�cWor��ree s <br />ip��l (B11 <br />Lf53 �Ppl FPP FTi11 S . � <br />1)lldnfn�Uli f 2'� <br />_�?-��-F--QL <br />Phon� <br />Nppnceni mamnynuu�ess i.uy Lip YhOf12 <br />Proiect Address Uf known) <br />Attach luw (4) copiea of 41ans for proposed work � Drew to scalo an�� note �he following as appllcable: <br />• Properry Linas • Centedine ol streel <br />• Oulline and dimensions ol ell ezisting entl • Indlcn�e Noith <br />proposed strudures on the lot • Show any proposed grading changes <br />• ExletinB and proposed ulilitles • Show mPasurements <br />PERMIT CONUITIONS <br />1. Atl calle br Inapectlon ehell be made 24 hrs. in advance • phone 259•881 O, <br />2. All work shell be pertormed in eccordanca wilh this permll end current City ol Everelt Design end Constructlon <br />Stenderde end Spacllicetlona. <br />3. Catl Locetion Underground Service 48 hra. belore you dig. TOLL FNEE NUMBER i•800•424•5555. <br />�. Tarta` p2�vE��Y �v � vTF4 � tJ FIZONT 1 d�.i�. t� SEi" L�.c.K <br />iy�' TO Ex�c� L.O' <br />� ,�.�r-o.,� i-2.�,J t�P-r� 6-9-9z� <br />�m.. 4 rvl�bzP 8- �J-90 <br />Approve ' r Conslruction Dale <br />� ����� /' � �'j <br />FI�Y L INSPE ION� Date <br />Approvetl ae Conslruclad <br />everett PUBLIC WORKS DEPARTMENT <br />� 32001:edar S�ree� <br />Everetl WA 98201 <br />Phone:259•BB10 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />W <br />H <br />� <br />� <br />O <br />� <br />� <br />� <br />a <br />The untlersi9ned ownei/apphcant hereby agrees to holtl and seve harm• <br />less the Cdy ol Everetl irom any and all claims lor dameges. cosis. <br />expenses, or causes ol action that may nrise because ol ins�allation <br />and malntenance ol thc improvement or other righbobwey use herelo <br />epplied for entl lurlhci ngrees lo removo same upon nolice Irom the <br />City and to r�place pubhc proprrry damageG thereby. <br />Signature ol pphcant �� <br />WORK AUT ORIZ[D BV THIS PERMIT MUST BE STAPTED WITHIN <br />1B0 DAVS OF DATE PEFMIT IS ISSUED AND THEREnr7ER IS TO <br />B[ DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAV B[ <br />CANCELLED BV iHE C17Y UPON ANV STOPPAGE OF WORK ON THIS <br />PROJ[C70VER90 DAYS DURA?ION <br />