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�ate �z: , ,; Y/ z B ( <br /> Pvbec Worx�Permil� <br /> Application For moo oeoi.._ <br /> PUBLIC WORKS PERMIT Pu1TotelFeeFee s ---- <br /> LeaAoo� �eePud s � <br /> Print or Type Only Baience�ue .5=���—�� <br /> T/�c' da��� l'r�. ���,. <S�X �'>��� i�is �� i�. . s'r��< <<% I'qi�Y 2zn:' .i'v> ��.3. <br /> Owner Meiling Atldress City Z�p Phona <br /> O�U�y��/- <br /> Applic.ant Mailing Addross City Zip Phone <br /> De5cri6e �ropOsedWOrk -/�1.Sf: (!o �`.��i�, p7C � ��� �flf� f �,�_ <br /> 27' t/rr %n-SG ,�J'. -.lo::�n <br /> v <br /> Project Address(it known) .jOO.J' - Gf� ('qsyi�p I�� � <br /> Attach lour(4)copies of plans lor proposed work- Draw�o scale and nole�he following as applicable: � <br /> • Property Lines • Centerline ot street � <br /> • Oulline and dimensions of all existing and • Indicete North <br /> proposed siructures on the lot • Show any proposed grading changes <br /> • Exisling and proposed utilities • Show measurements � <br /> DO NOT WRITE BELOW THIS LINE <br /> PEqMIT CONDITIONS O <br /> 1.All cails lor fnspectlon ahall be mede 24 hra.in advance-Fnone 259•8810. � <br /> 2.All wark shall be peAormed in ecwrdance with this permU and wrrent City of Evereq Design and Construction <br /> Standards end Specifications. <br /> 3.Call Location Underground Servlca 48 hrs.before you dig.TOLL FREE NUMBER 1•800-424•5555. � <br /> � 1�;�,-r,� �o � ��i, `���/�1��.�5 ��ff'irv;�cY ./,� <br /> f/,c �%�,��h',Llc [�n.�,Ft �`,7�- �,� � O <br /> i 7-1,�5-�/ <br /> � <br /> � <br /> O <br />, <br /> a <br /> ACKNOWLEDGEMENT Of CONUITIONS <br /> The underslgned ownedapplicant hereby agrees to huld and save harm� <br /> less the Cily ol Eve�ett irom any antl all claims lor tlumagus, costs. <br /> expenses, or causes ol action Ihal may arise because o� instellation <br /> • � /���"�_ � �r-�� and maiNenance ol the improvement or other right-ohwey use hereto <br /> Y� applied for and further agrees to remove same uUon notice from the <br /> App� or onsirucllon Date <br /> r , Cily and lo replace public properly damaged ihereby. <br /> ( ��/%'����.�-���/S� � ,,, <br /> FINAL�J�E I�T O—N� <br /> Approved as Consirucled Siqnalure Applicar�l Date <br /> � PUBLIC WORKS DEPARTMENT WORK AUTIIORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> 32WCeaar5lroet 1B0 DAYS OF DATE PERMIT IS ISSUED AND TNEHEAFTER IS TO <br /> Everelt,WA 98201 BE DILIGFNTLY PURSUED TO COMPLETION. THIS PEFMIT MAV BE <br /> Phone:259�8810 CANCCLLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJ'cCT OVER 90 �AYS DURATION <br /> �� <br />