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Date `� 7I{1✓ Pu�lrcWodsParmitpe �`� + ��� <br /> ApPliwtion For o�ao oeo�.• p � �L�%a� 3 ! <br /> PUBLIC WORKS PERMIT PuOToIeIFsaF°° : <br /> �eca Ao��Fee Peid S <br /> Balanta Due S a�� <br /> Print or Type Only <br /> --�ap��tle�---���Y�'1����¢[�1�D��P .�,�.7�'�n/ ��J,d�'.�e�,� 9�r�.� �3�:�� <br /> Owner Mailiog Address Citv � Zip Phone <br /> � _rr n 1� ��_/�1�� 7� 7J S�C'AL�/:b//!7(a.o��{w�—J—C>�7—�Vl �'(`� _ <br /> Applicant Mailing Address C�tyi Zip Phone <br /> Describe Proposed Work � Pw r ?-n��('}�p� ro . Ln� /_3 1 ..t/LC�ri�'�_ . <br /> p W <br /> Prolect Address�if known) � �7�/ ' C.OlrEI7�Qe L.lJ� � <br /> Attach lour(4)copies of plans for proposed work- Draw to scale and note the lollowing as applicable: � I <br /> • Properry Lines • Centedine of streel � <br /> • Outline and dimensions of atl existing and • Indicate North � <br /> proposed structures on lhe lot • Show any proposed grading changes <br /> • Existing and proposed utilities • Show measurements � <br /> DO NOT WFITE BELOW THIS LINE O <br /> PERMIT G�NDITIONS � <br /> +. All calls for inspection shall be made 24 hrs. in advance- phone 259-8815. � <br /> 2. All wore shall be performed in accordance with this permit and current City of Everelt Design and Construction <br /> Stand�.rds and Specifications <br /> 3. �;�II Location Underground Service 48 hrs. belore you dig.TOLL FREE NUMBER 1•800•424•5555. � <br /> /!%t�?E = C/Ty f��9S �✓4 1Nfo,er�ATioN d,c/ SEiuEQ Srdi3 O <br /> rCOCAT/oN � AS-d!//�TS NOT (/E�C'/FiEO ,A�D <br /> /�E✓_=�or�F.� f�As �c.%✓E,� .LGc.9TE1� �rv�3, � <br /> V♦ <br /> O <br /> � <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> � 7he undersigned owner/applicant hereby agrees to hold and save harm� <br /> less the City of Everett Irom any and all claims lor damages. .:osts. <br /> ezpenses, or ca��ses of adion that may arise because ot installation <br /> �-�i�• ���o�_ ���,��� and maintenance ol the imGrovement or other right-obway use hereto <br /> �'J��ff applied lor end lurther agrees lo remove same upon notice hq�r� Ite <br /> Approved for Conslr ction Dale Ciry and lo replace public properry damaged Ihereby. <br /> � ' � s= 3-a <br /> FI AL INSPECTICN Dat <br /> Approved a5 COns�ruc�ed SignaWre ot Applicant Oate <br /> evere« PUBLIC WORKS DEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> � 3200CedarStreet 180 DAYS OF DATE PEFiM1T IS ISSUED AND THEREAFTER �S TO <br /> Everutl,WA 98201 BE DILIGENTLY PURSUED TO COMPLETION. TIiIS PERMIT MAY BE <br /> Phone: 259-8815 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAYS DURATION. <br />