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�� <br /> � � <br /> �� � <br /> A � � i <br /> � H [n � �1 <br /> H� � (� - 4'-7_r-�'; -5 <br /> �C O Date���� r�eecwoiksve,�n. .� L�'� 7 <br /> O O . 90�a,�� <br /> yd H ytl r,�plieation For eiao�oer�.•_ <br /> ��� PU�LIG yV'ORKS PERMIT °°°��°W°��°°°° — <br /> T[IelFee g_ <br /> � Less AOC� Fco Pai� $ <br /> ��� Baiance Due S�-� I <br /> ,�,� � Print or Type Only <br /> 4� O I <br /> ti <br /> ty H� ���-r l,-� .{�uP�t��l�-I�Jii1L�.�, � � �/�/��; ��ln. s,c��U�/ / ���q4��rtl� i'.f"G3 � I <br /> �"� y Owner � Mai'ling Addre�s Cily � Zi Phone <br /> y 355-aoa / <br /> gdti <br /> �� � Applicant Mailing Address C'y Zip P ione <br /> y O V1 /V C�!J {� Y�C'� Y � It� ,��/ �N I.Y L� � L��✓ �/� � <br /> Describe Froposed Work /�E (L_/� ! J/ H!1( � /V I <br /> �F,/G�� /�1 /� �/ oZ I <br /> c��c'�a ���_� c,-T w�Y W i <br /> Project AAdress lil known) � <br /> I <br /> Attach tour(4)copies of p:ans lor proposed work-Draw to scale and note the following as applicable: � <br /> • Proper�y Lines • Centerline ot street /^ . <br /> • Outline and dimensions of all existing antl • Indicate North V� <br /> proposed structures on ihe lot • Show any proposed grading chari9es <br /> • Existing and proposed utilities • Show measurements � <br /> ���� DO NOT WRITE BELOW THIS LINE O <br /> � PERMITGONDITIONS <br /> � 1.All calls for inspection shall be made 24 hrs.in advance-phone 259•8810. � <br /> �.All work shall be pertormed in accorAance witn lhis permit and current City ol Evmett Desigr and Construction <br /> �� � Stendards and Specilicdlions. <br /> I —� 3.Call Location Underground Service 48 hrs.before you dig.TOLL FflEE NUMBER 1•800•424•5555. s <br /> I � <br /> I� 1�� � <br /> I �+1. <br /> � <br /> !,1 i � <br /> �' Q <br /> . a <br /> � <br /> , __ <br /> I _ ,�p AGKNOWLEDGEMENT OF CONDITIONS <br /> I � _�� The undersigne�i owner/appllcaM hereby agrees to hold and save harm� <br /> l '� <br /> � less ihe City o� Everelt Irom any and all claims lor damages, costs. <br /> expenses, or causes ot aclion ihat may arise because ol installation <br /> � C �r.C� `� �� Cy^ and maiNena•ice ol Ihe im rovement or other ri hbol�way use herelo <br /> �'-�� � ��i� "-"�. �— /� `�"-'��� applied lor a�id furiher a�rees to remove same upon nolice Irom ihe <br /> Approved lor Construc � n Date Ciry and�o replace public property damagetl Ihereby. ` <br /> iGf��/ � -�1-'S'� �/,� �/��iylA- // <br /> FINAL INSP TION Date �1��.��-Ll1 � I/ 90 <br /> App�oved as Conslrucled Signature ol AppTcant Date � <br /> everelt PUBLICN'ORKSDEPARTMENT WORK PUTHOF7IZED BY THIS PERMIT MUST BE STARTED WITHIN � , <br /> I80 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTFR IS TO <br /> � 3200 Cedar Street BE DILiG[NTLY PURSUED TU COMPLETION. THIS PEFMIT MAY B[ <br /> Everoti.WA 98201 CANCELLED BY THE CITY UPON ANV STOPPAGE OF WORK ON THIS <br /> Phone:259�8810 PROJ�CT OVER 90 DAYS DURATION. <br />