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Date_�"'-7__� � ���.��., �;,....��._.��. _ / <br /> AnP6calien For �.�.�.� n.r� . y 9/�o�tQO/_ .. . <br /> PUBLIC WORKS PERMIT - <br /> �;,;,.�,�w,.,..,-.� <br /> ������P� s_ — <br /> «,,.�„� �.��.,, s— <br /> Print or Type Jnly n,�a��.n,�� s_ _ <br /> /yl(z�a,'f �a;� es ��Oa3 - yy .,4'.E Eva.a,,� 9�zo� 3 s� -zo3� <br /> O e� Mnihny AAAiess GIY 7ip Phone <br /> �veiertf- alcP�s J.c 51co6 ���2�—��r1r1'}�_�.2a 3 353-7�6� _ <br /> Appl�cant Maihng Addres Ctly 2ip Phone <br /> Describe Proposed Work �� (y�1?�vl__��Q%/' . <br /> Project Address�il known) �lYyY L�1P.l�d u,� � <br /> Attech low(4)copies ol plans lor propOsntl work- Draw lo sr.ale and note Ihe lollowing as apPlicable. � <br /> • Property Lines • Genlerline oi sVee� � <br /> A Ou1Gne and dimensions ol all exlsling and • Indicale North <br /> pioposetl structuras on ihe lot • Show nny proposetl grading changes <br /> • Eaislmg and proposed ulihties • Show measuremr.nis � <br /> DO NOT'vVRI1�E BELOW THIS LINE <br /> PERMIT CONDITIONS O <br /> 1.All calls for Inspection ehell be made 24 hrs.in ndvance•phone 259•8810. � <br /> 2.All work ahall be pedo�med In eccordence with this permit end current City ot Everell Design and Construction <br /> Stenderde and Specificatlone. <br /> 3.Call Loeetlon Undarpround Service 48 hrs.betore you di{�.TOLL FREE NUMBER 1•800-424•5555. � <br /> O <br /> � -� � ' � � �.�(� <br /> . G��C LIIOZ/�� �L�✓'2�,7.< � �'' � `�/� H <br /> � � <br /> i�j / �����.f-_ � <br /> �i/ � _ V"� O <br /> a <br />�, ACKNOWLE�GEM[NT OF CONDITIONS <br /> The undersigned owner/applicant hereby ayrees�o hold end sava hnrm� <br /> Iess the Ci1y ol Everelt �rom any and all claims lor damages, cosis. <br /> e.penses. or causes ol aclion thal may a�ise because ol inslallalion <br /> and mainlenance ol ihe �mprovemenl or olher ngh��ol�way use heieto <br /> applicd Im and lurther agrees lo remove same upon nohce Irom Ihe <br /> Approved lor Conslrucfion Dale City and to ieplace public properry damaged ihereby <br /> FINAI INSFECTION Dale <br /> Approved es Consiruded Signnture ol Apphcanl Dale <br /> everett PUBLICWORKSDEPARTMENT WORK AUTHORIZEO BY THIS PEFlMIT MUST BE STARTED WITHIN <br /> � 3200CederSiree� 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Eve�ett,WA99201 8E DILIG[NTLY PURSUED TO COMPLETION THIS PERMIT MAV Bi <br /> Phone�.259�8810 CANC[LLED BV TfIE GTV UPON ANV STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAYS DURATION <br />