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.�. <br /> . �:.---, <br /> _ ---_��;-- .,,«, , .. . _ , .. . . . ., <br /> � I � ��-.II ' <br /> I„ ' Date ' ��,'� `�` � ' �" _' PuEIm WodnParm� . , '�/ —�� r� <br /> I .. Ei�F D�ot.� _=�.11..G . <br /> Application For <br /> � PUBI_IC WCIRKS PERMeT PuOToIalPocfce 5 <br /> I Loss Rnp�.Fee Pa�e S <br /> ��� 'I Ba�ancc�uc S__ <br /> a H I Print or Type Only <br /> A�7"C <br /> 9 �-I I li <br /> r3 CA ` ) / '/ /� I <br /> H �3 � � � � r �f � I �I��(� �.// � ��{ Phon � <br /> � Z H � L Qrmer `(-'��� Mailing Address C�ly Z�p <br /> rC C] <br /> O x O �. <br /> y y� �i Malting Htldress City � Zip Phone <br /> Applicant <br /> z <br /> � y� 7- � <br /> O H �. Describe Proposed Work <br /> Hn�y <br /> /1 C�7 O � —'--- . <br /> Y�V C�].� <br /> H I � I <br /> 7H3 � W <br /> > H LTJ � <br /> � i-+H � -..�. i� ';� � (/.�j' 1 .. / � I , � <br /> y I Project AdCress lil ,.nown� <br /> H ... .� �.. ' � <br /> O C V� j �� � <br /> � �n Attach lour(4)copies of plans br proposed work- Draw to scale and note the following applicable: � I <br /> • Property Lines • Cenlerline of streel <br /> Z H(/� ' • Outl�ne and .fimensions ol all ezisling and • Indicale Norih <br /> y �y �. proposed siructures on ihe lot • Show any proposed grading changes I <br /> • Show measurements /� �I <br /> � � f.� Eaislin9 and proposed ulilities w <br /> � ! —� DO NOT WRITE BEI.OW THIS LINE /y I <br /> V j <br /> � PERMITCONDITIONS ^ <br /> i ' 1,All calls tor inspeclion shall be made 24 hrs.in advance•Phone 259•8810. <br /> ( �� 2.All work shall be pedormed in accordance with this permil and current Gity of Everelt Design and Cons'.ruciion ♦ <br /> � `"' `r' � Standards and Specifiwlions. <br /> I �..� i 3.Call Location Under9round Service 48 hrs.before you dig.TOLL FREE NUMBER 1-806•424•5555. � <br /> I <br /> � � / �L�f G.'t"C. '� <br /> � i� � ���:_l_�<- ���-'C.�_,� �._ , <br /> �� <br /> �, � '—���.� 4l�� ` (�. � <br /> I <br /> 7- � � <br /> � . .���_ c.. <br /> I ��) ' I . 1�6 <br /> ���v' I i <br /> n� <br /> 'I ACKNOWLEDGEMENT OF CONDITIONS I <br /> � The undersigned owner/applicaM hereby agrees to hold and save harm� <br /> +e a I less lhe Ciry oi Everell irom any and all claims tor Aamages. costs. I <br /> � ezpenses. ci causes of action ihat mav arise because o� inslallat�on <br /> �I and maintenance of ihe improvement or other righPotavay use hereto <br /> app�ied �or and further agrees to remove same upon noCce Irom the <br /> 'L�J Approved lor Cunstruclion Date C�ty and to repiace public property damaged thereby. <br /> FWAL WSPECTION Date Date <br /> �I AF���' ��ed as Constructed <br /> Siqna�ure of Applican� <br /> � BORDAYSTJOF DATE PERMITISEISSUED AND THEREAFT�ER ISHTO <br /> everett PUBLIC WORKS DEPARTMENT — <br /> � 3200CedarStreet BE DILIGEN7LY PURSUED TO COMPLETION. THIS PERMIT MAY 6[ <br /> IEveretl WA 98201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone.2:9-8810 PiiOJECT OVER 90 DAYS DURATION. <br />