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. <br /> _ _ ,.�,�� <br /> ,. <br /> Dat�S�–c5'-8p 4 ���o�,�.wo,w.va,m,�. —$ 9-.3/E <br /> Appti[aticn For smq Deoi • _ <br /> ' PUBLIC WORKS PE�MIT PuGTOW`�sfre s--- _ <br /> ��� tes.�noi �»�'.+�n S <br /> �� <br /> `�' : , � e,�,�.�o„� s �Ova <br /> Print or Type Only _ �� '-' <br /> '-i r� o <br /> ..� PJ [9 <br /> M Y+ <br /> N �eLflM -1RIN 27ZS �y �ve�{}- �� Z-o� - ZS2-31S8 , <br /> Ownei MailmgAdtlress �? -� �� 3_ Ctly Z�p Phone <br /> iri ri :t �.q <br /> � r� j . <br /> \ J fi <br /> M,.�I,,:� �w-�N 27vS, �b�, a � v� �I . <br /> Applicant Mailmg Address —� C�ty ip Phone <br /> �A p n � � n ' � rY <br /> Descnbe Proposed Wo�k _ 1•�Q� I�AVECY VC d Ip�fK � �t.vv.s-�M ._ <br /> 1�. <br /> �r <br /> ofF o{ F��[.� O.V[ <br /> Proiect Adaress(ii knownl 22 dZ' �¢� V�� � �Ij� �(J � � <br /> � <br /> Attach low(4)copies of plans lor proposed work- Dr to scale and note Ihe lollowing as appllcah�e�. � <br /> • Property Lmes • Cenlerlme ol street � <br /> • Outline and Aimensions ol all ezreting and • Indicale No�th <br /> proposed slructures on the lot • Show any proposeA yradinG changes <br /> • Exis�ing and proposed utiLtieS � Show measurement5 � <br /> DO NOT WRITF BELOW THIS LINE O <br /> PERMITCONDITIONS <br /> 1.All calls for inspection shall be made 24 hr5,in advance-phone 259•8810. � <br /> 2.All work shall be periormed in accordance with this permi�and current City ol Everelt Design and Construction <br /> Standards an0 Specilications. <br /> 3.Call Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1-500-424•5555. � <br /> � ' <br /> � � � <br /> � � � <br /> �� GV <br /> 7 � �� �, � � � <br /> �' � U� <br /> � , <br /> P� �� '��n �� <br /> � ,���� � p <br /> � ' a <br />� �,,�. � � c. L ,�' �n�� <br /> � � � <br /> � `� �' ��' ��� � ��- � <br /> �- I C�� ACKNOWLEDGEMENTOF ONDITIONS <br /> � <br /> The undersigned owner/applicant hereby aq�ees to hold and sa�e harm� <br /> less the City ol Everelt I�om any and all daims for damages. wsts. <br /> /i���✓ o a� � e*penses, or causes ot artion ihat may arise because ol installation <br /> c��� 0 and maintenance ol Ihe improvement or other right-ol-way use hc�eto <br /> ��'�� appGed lor and f Iher agrees to remove same upon noGce Irom Ihe <br /> Approved im Gonslru ion Dato Gity and to replac�pubhc pronerty d maged ihereby. <br /> FINAL INSPECTION Date I���� <br /> Approvnd as Construc�ed SignaWre ol Applicant Date <br /> everetl PUBIICWORKSDEPARTMENT WORK AUTHOFIZE V IS PEqM1T MUST BE STARTED WITHIN <br /> 180 DAYS OF DAT� PERM IS ISSUED AND THEREAFTER IS TO <br /> � 3200CedarStreet BE DIL�G[tJTLY PURSUED 1 COMPLETION. THIS PERMIT MAY 8[ <br /> EveretL WA 982Ct CANCELL[D BY THE GTV UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone:259�8810 PROJECT OV[R 90 DA"5 DURATION. <br />