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�0}B�/y / P�eiK wort.r��mn• � � L <br /> Applicatlon For Bie� o•o��•� <br /> PUBLIC WORKS PERMIT ^��;a;;�;;F•• , z�e, z <br /> L�U AOPI FN P�10 / <br /> Print or Type Only 8.�.��.o�. t 7�y� <br /> �aF�� <br /> (�i�,s fC�i„a,e�+�,u� is�o7 -l/6= N'�tJc�. ,L�of�rC/ /� S�'oii y��- ao'�_ <br /> 'Qy�fiar Meillnp Atltlreee Clly 21p Phone <br /> 14JIri ,�� 1�' UP�J2PJ V A 'nC.. ' <br /> Applican Malllnp Addrean City Zip Phone <br /> Daer.ribe P�opoeed Work v �� <br /> W <br /> Pro�ect Address(il known) ' — � � <br /> Attach lour(4)coplee ol plane(or propoaed work• Draw lo ncele end note the lollowing ae epplicable: �7 <br /> • Property Lines • Centerline ol street � <br /> • Outllne end dimenslons of all axlatlnp and • Indicate NohF. <br /> proposed etructures on the lol • Show eny p�oposed grading changea <br /> • Existinp and proposed ulllitlee • Show meeeurements � <br /> DO NOT WRITE BELOW THIS LINE O <br /> i <br /> PERMIT CONDITIONS <br /> �� 1. All calls lor Inepactlon ehall be mede 24 hrs In edvance• phone 259•8815. � <br /> I 2. All work ehall be pertormed In eccordance wlth thla permil and currenl City ol Everelt Uesipn end Constructlon <br /> Slendards and Speclllcatlone. <br /> 3. Call Locallon Underpround Sarvlce 4B hre. belore you dig.TOLL FREE NUMBER 1•800•424-SSSb. � <br /> 4 �—H- �ro„t�� �..5� � <br /> � <br /> � <br /> � <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The underelgred owner/applicant he�eby epreee lo hold end eeve harm- <br /> less thn Cit� ol Eve�etl from eny enA etl cleima lor damapes, cost4 <br /> ezpensR., or cauaea ol action thaf may erise beceuae ol Instelletlon <br /> ����� ����`�` /Z—�6liY antl malntenan ol the Improvemenl or other tlphl•o4wey uee herelo <br /> —a �T applied lor a her eg�ees to ramove eama upon notice I�om Ihe <br /> Approve or onetructlon Date Cify end 1 ublic propert qod Ihereby. <br /> __.��'�/ f• 1 2. �r- <br /> 'FINAL INSPECTION Dete <br /> Approved as Conatructed Signetura pp icen Dele <br /> everett PUBLIC WORKS DEPARTMENT WORK AUTHORIZED BV THIS PERMIT MUST E STARTED WITHIN <br /> � 3200Ceder5lreat 180 DAVS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everelt,WA 68201 BE DILIGENTLV PURSUED TO COMPLETION. THIS PERMIT MAV 8E <br /> Phone: 259•8815 CANCELLED BV THE CITV UPON ANV STOPPAGE OF WORK ON TIiIS <br /> PROJECT OVER 50 DAVS DURATION. <br />