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�.- <br /> � ~ <br /> b <br /> p M yZ /� <br /> � N N Puoilc Wo�ka Pe�mil e <br /> � � �c Date S��-� �Z' eiao�o�o�.• <br /> y � Application For <br /> WORKS PERMIT PUE1�cWo�kaFee g <br /> ° " ° PUBLIC TalalFae <br /> N M <br /> y z r'j Lesa AOP�Fee Va�d $ <br /> lVO W Balanco Oae g �^ <br /> �3 d <br /> H � Print or Type Only <br /> ~ryCy � ! �/ bl( Collese q�e E�-e�f(- 9`6703 z�z -3XY � <br /> t+ M �Ulv, J"�Sr/� � Z� phone <br /> y Owner Mailing Address C��Y P <br /> � o H — 2s'�-3�sy6 <br /> i � � rctl ����n S4r y6�/ Col(e c ��e l Uerc /�$ze3 <br /> y y Mailing Adtlress City _ ZiP Phone <br /> p Applicant / <br /> Describe Proposed Work <br /> �U1I� ��NCC' l77 SP�/� / I,S(�Y' O'F G✓CS� �JE�G✓PPvI __ <br /> rei /'a i <br /> — W <br />� Prolect Address(it known) <br /> yco(/ c�( lese �Ye �oererf- - � <br /> � <br />� Atlach tour(4)copies oi plans lor pwposed work• Draw�o scale and nole the following as applicable: � <br />� • Properry Unes • Centerline of street <br /> • �ndicale North <br /> • Outline and dimensions ol all exisling and � Show any proposed grading changes <br />� �.,. proposed struclures on the lot • Show measurements M <br /> � � • Existing and proposed ulilities W <br /> I ��� DO NOT WRITE BELOW THIS UIdE O <br /> � PERMIT CONDITIONS ^ <br /> '�� 1.All calls for inspection shall he made 24 hrs.in advance•phone 259•8810. <br /> �= 2.All work shall he performed in accordance with this permit and current City of Everelt Design and Construction ♦ <br /> Standards and Specifications. � <br /> ' 3.Call Location Underground Service 48 hrs.belore you dlg.TOLL FREE NUNBER 1•S00•424•5555. <br /> �20� /� <br /> i N -7��hC�ICG I.'� M iC1C� 1< O� /��S'I�7' O T 4.C� O <br /> __ ♦ <br /> 1'LO� � �..��,..,.{ .�c ,u'I,,-,�1; <br /> (w^ru o � <br /> !�I I �t/ � � M � <br /> 4611 O <br /> �}u�.5e <br /> . � _ _ a <br /> _,_, _ _ _ <br /> _ _ -co� �esf-'`� � <br /> i � <br /> \' <br /> �I I. ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant herehy agrees lo hold and save harm- <br /> less ihe City ot [veretl Irom any and all claims tor damages, coslS <br /> �ezpenses, or causes of aclion Ihal may adse because ot inslallalion <br /> � � and mainlenance ol lhe improvement or other righPof-way use hereto <br /> �pplied for and lurther agrees lo remove same upon nolice irom lhe <br /> ppro.e I Constru on �« Ci1y and to replace publ�Pert damaged thereby. <br /> ,., , � y ,S-/Z-S'Z <br /> INAL INSPECTION a Date <br /> ,pproved as Construded <br /> Signalurc ol ApPlicant <br /> WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WI <br /> " - PUBLICWORKSD M�,py 1 2 i��� 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> /I'� 3200 CedarSlreot BE DILIGENTLY PURSUED TO COMPLETION.THIS PERMIT MAY BE <br /> �rEverelt,WA90201 ....................., , � •��•�-�^^-" CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> �� Phone:259�8810 � ' � �I�� ��T PROJECT OVER 90 DAYS DURATION. <br /> � , � .. . .�,. <br />