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90- ��r <br /> � {'u���c 1Vo�ha Pe <br /> �� ���,� �'� � > /�-; � <br /> � p r+ Date ��" amg oeo� • — <br /> � .+ Applicnlion For <br /> �y p� Publ¢Worke ioe $—_ <br /> '°�� � � IC VVORKS PERMIT T��,��°� <br /> C �"� P�� LessPOG�FcePaid S' <br /> 9� H N <br /> y � � � sz= <br /> a�io��a o�e 5� <br /> $ To posTiNc ��5� <br /> o c o Print or Type Only� d <br /> w Q� <br /> N i-! /— '//���� ��! �1 ''(Y�, <br /> � mO � ,J /� y-�r.' . � o:[� {�C'/lC �(�)l. 1 � C t � " �� � <br /> � y � C I l,�I C. .� C� � � o�K`1?��'L'C ress F City ZiP rnan <br /> °� "n � oW e� a o 9 d `�o�o�.�� <br /> � :° � g � V <br /> �y'� � Z�p Phone <br /> Y ��-] M Mailing Address City <br /> t^ �„i H qPPlicant / <br /> eee��� N l'1 L.� n .�L(, _�------ <br /> JC � N �_ J i �/I / // Y 1 <br /> � � � Describe Proposed Work <br /> H O N `� � I <br /> ii� <br /> ..59�0 — n v r <br /> Proiect Address lil known) �� <br /> qilach lour(4)copies of plans�or proposed work- Draw to scale and note�Cco11ewine ot sipee�able: � <br /> • Property Lines • Indicale Norlh <br /> • Outline and dimensions ol all existing and � S��pW any proposed g�eding changes � <br /> proPosed slructures on lhe lol • SI•�ow measurements <br /> • Ezisting and proposed utilities O <br /> DO NOT WRITE BELOW THIS LINE <br /> PERMIT CONDITIONS hone 259•8810. ♦ <br /> ' �-', 1,All calls lor inspection shall be made 24 hrs.in advance•p <br /> � � ' � 2,All work shall be pedormed in accordance with Ihis permi�and current Ciry ot EvereU Design and Conslruclion � <br /> � Standards and Specificalions. <br /> 1 3.Call Location Underground Service 4B hrs.betoro you dig.TOLL FREE NUMBER 1•800•424•555 . � <br /> _' / � o�on�^ cr �anS <br /> � <br /> � � � ,S � u,��,� fo 6� , P ' �' �o-��-.L <br /> / 6y p�,��,� c.Jor,E.r a�/ � <br /> qP�i-o vp a <br /> ��� � <br /> � ,, --- � ` � <br /> U l�� O <br /> �� ` ���, - a <br /> _ �ti��.- �r� <br /> -�- cj� �� � i3 '2 <br /> � <br /> � '�� � v ' �� � ., <br /> _1 ' , r CKNOWLEDGEMENT Of CONDITIONS <br /> �,I '� The undersic�ned ownedapplicant hereby agrees to hold and save harm� <br /> less the City ol Everelt irom any and all claims for damages. costs, <br /> expenses. or causes ol action ihat may aiise because ol installalion <br /> I ` /D 26�9� and mninlenance of ihe impwvemenl ar olher righbol-way use herelo <br /> I �'+ � •���� applied'lor and lurthcr a9rees lo remove same upon nolice iwm lhe <br /> \ YL � Dale Ciry a d replace puhlic propertY damac�ed thereby. <br /> qpproved far Construofion � / <br /> ��� /i � / _ 3J —�i' / ��(„��L�L�' �� ��Z��J��[1 <br /> r�(, ,�—'_' ��� � <br /> ` D�te <br /> FINAL INiPECTION Signature ol Applicant <br /> ppprovedasConslruc�ed yyORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WRHIN <br /> PUBLICWORKSDEPARTMENT 780 DAYS OF DATC- PEFMIT IS ISSUED AND THEAEAFTER IS TO <br /> evcrctt BE DILIGENTLY PURSUED TO COMPLETION.THIS PERMIT MAY BE <br /> � 3200GedarStreet CAIJCELLED BY iHE CITY UPON ANY S70PP�GG OF WORK ON 7HI5 <br /> Evcrett,WA 98201 pROJECT OVER 90 DAYS DURATION. <br /> Phone:259�6810 <br />