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f( - i3-�°�-9 <br /> Date Puehc WerMe Permil• �/L Z <br /> AppliCetion FOi B�ey Deoi • <br /> PUBLIC WORK� PERMIT PU�ioi�FeeFee � loo� ? 3i <br /> . , Lea��P01 Fee P�id � <br /> Pflf11 Of Typ@ Oflly ssie��eo�e f �lJ�7�3 J=' <br /> Ev-sv����'��.-�ii..��� �,N� �i� �,.�n�s^s�i� ��O fi�-iD! ,re l�2>S <br /> Owner/ , MelHng Atltl�ess C�ty Zi Phonc <br /> Applica�t Mailing Address Cily Zip �Sphone <br /> Describe Proposed Work ��//�N�/�[J� <br /> / <br /> ProjectAddresslifknown� ��_`Aj/�x� � <br /> Aftech Imu�4�copies ol plans br proposed work� Draw to scale end note the following as appfica6le: � <br /> � Property Lines � <br /> • Cenlerline ol slreet � <br /> • Outline and dimensions ol ell existing and • Indicate Norlh <br /> proposed slruclu�es on ihe lot • Show eny proppsed grading changes <br /> • Ezisting and proposed utilities • Show meesurements <br /> DO NOT WRITE BELOW THIS LINE � <br /> PEFMIT CONDITIONS O <br /> 1.All calls lor inapectlon ehall be made 24 h�e.In advance•phone 259•8810. <br /> 2.All work shall be peAormad In accordance with this permlt and current City ol Everelt Design and Const�uction ' <br /> Stendards and Specilicallona. <br /> 3.Cell Locatlon Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1•80Q•424•5555. <br /> �i�. //.wa�/�.���r.r ��� g �zs- .q z Z <br /> / O <br /> �� <br /> V� <br /> 0 <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The unde�signed owneUapplicanl hereby eg�ees to hold and save harm� <br /> less Ihe Ci�y ol Eve�ett Irom any end all claims lor tlamages, cosis. <br /> .�� expenses, or causes ol action Ihat may arise becnuse of ins�allation <br /> antl mainlenance ol � improvement or other right�obway use hereto <br /> Approv Co ructi p �e applled lor and Imth. agrees fo remove same upon notice Irom the <br /> '�_ - %� C�t o replace h e�ty damaged ihereby. <br /> ' = �' . , —�:���- l�–�,�s�'v/ <br /> FI L P CTIO ' ' Date gj <br /> Approved as Conslruc�ed <br /> Sign o plic e <br /> � PUBLIC WORKSDEPARTMENT K AUTI RIZED BY THIS PERMIT MUST BE STARTED WIiHIN <br /> 3200CetlerStreet 18 DAYS OF �ATE PERMIT IS ISSUE� AND THEREAFTER IS TO <br /> Everetl,WAg8201 6 DILIGENTLV PURSUED TO COMPLETION. THIS PERMIT MAV BE <br /> Phone:259-BB10 CANCELLED BY THE CIl"Y UPON ANV STOPPAGE OF WORK ON THIS <br /> PqOJECT OVER 90 DAYS DURATION. <br />