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W ~ <br />�C <br />M <br />b � <br />b F3 Vi <br />i <br />y M <br />K F� <br />�U M '9 <br />� N � <br />z <br />ro <br />O H �7 <br />H W O <br />G7 • (� <br />� y �M <br />N <br />H <br />� tU t+ <br />H O tn <br />�����„ <br />��, <br />�._ <br />Date 7/�7 /a� <br />Applicalion Foi <br />PUBLIC WORKS PERIVIIT <br />Print or Type Only <br />Vuohc vrorw, Permn . � r� O / <br />ema.oep�., 37575 <br />Pu�LC WorMS Fee <br />To�alFco 5 <br />Less R001. Fee Paid $ <br />o.,ia��a o�e 5 7(� � <br />KJCO INC 333 SW Everett Mall Way �Fv�rett 9A704 747–d��� <br />Owner Mailing Address ., , City Zip Phone <br />Owner <br />Applicant Mailing Address City Zip Phone <br />Describe Proposed Wo�k <br />Prolect Atldress (if known) <br />Attach four (4) copies ol plans lor proposed work - Draw to scale and note the lollowing as applica6le: <br />• Property Lines • Cenledine ol streel <br />• Outline and dimensions of all existing and • Indicate Norih <br />proposed strucWres on the lot • Show any proposed grading changes <br />• Existing and proposed utilities • Show measurements <br />PERMIT CONDITIONS <br />1. All calls for inspection shall be niade 24 hrs. in advance • phone 259•8810. <br />2. All work shall be pedormed in accordance with this permil and current City ol Everelt Design and Conetruction <br />Standards and Specifications. <br />3. Call �ocation Underground Service 48 hrs. belore you dig. TOLL FREE NUMBER 1•800•424•5555. <br />a <br />:�����= 8�1�9z <br />Approved I onslruction Date <br />l � <br />�� /G � <br />FINA INSPF.CTION �ele <br />Approved as Constructed <br />Pl1BLIC WORK$ DEPARTMENT <br />—1 3200 Cedar Sireet <br />.��% Everelt, WA 98201 <br />Phone:259�0810 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />�1 <br />• <br />z <br />0 <br />The undorsipned owneqapplicant he�eby ac�rees to holC and save harm� <br />less the City of Everetl Irom any find al! r,laims lor damages, cosls, <br />ezpenses, or causes ol action ihat may arise because ot ins�allation <br />and maintenance of the improvement or olher righ�-ol-way use herelo <br />applied lor and lurlher agrees to remove same upon notice trom ihe <br />Cily and to replace public property damaged ihereby. <br />� � z�- c'/Z_ <br />Si ture ol pplicant �ate <br />WORK AUTHOPIZED BY THIS PERMIT A1UST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BYTHE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />