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I Date�B \ � PuOim WorAs Perm�u _ <br /> eie oen�.• � <br /> Application For c _ <br /> PUBLIC WORKS PERMIT P��LCWorksFea — <br /> Totnl Fea S <br /> Lesa AOC�-Fee Paid S_ <br /> P�Iflt Of TypB O�lly Balanca�ue S <br /> -�-�fC--S�el�o �. ��Ciq��e�p�- ��n �vr�p��8"z.ri i �l�FI� a6.P� <br /> Owner Meding Address Ciry 2ip � Faone <br /> S�w� p <br /> Applicant Mailing Adtlress City Zip Phone <br /> Describe Proposed Work hFvYlbN'P. � `f O�P'A <br /> W <br /> Pro�ect Address(i1 known) � <br /> Altach four(4�copies ol plans for proposed work- Draw to scale and note the lollowing as applicable: � <br /> • Property Lines • Centerline of slreet � <br /> • Outline and dimensions of all exislinc�and • Indicate Norfh <br /> proposed structures on the lot • Show any proposed grading changes <br /> • Existing and proposed utilities • Show measuremants � <br /> �O NOT WRITF BELOW THIS LINE <br /> PERMIT CONDITIONS O <br /> 1.All cells for inspection shall be made 24 hrs.in advance-phone 259-8810. � <br /> 2.All work ehell be performed in accordance with this permit and current City of Everelt Design and Constru^.tion <br /> Standards and Specifications. <br /> 3.Call Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1•800-424•5555. � <br /> /� �rp ' /� �/ `t t�-B8 <br /> / G�/,�tC� L.Jtrz�r�mc��v� /,yciJ�-`Cct�✓' <br /> � <br /> , � -��,� <br /> � <br /> � <br /> O <br /> a <br /> ACKNOWLEDGEMENT OF CONDITION3 <br /> _ The undersigned owner/applicant hereby agrees to hold and save harm• <br /> less the Cily ol EvereU �m any and all claims for damages, costs, <br /> expenses, or causes of ac���n that may arise because ol inslatlation <br /> and maintenance ol ihe improvement or o�har right-of-way use hereto <br /> apFllied lor and further �grees to remove same upon notice from the <br /> AOP�oved for Construction �a�e City and to replace public property damaged thereby. <br /> FINAL INSPECTION Date <br /> Approved as Constructed Signalure of Applicant Date <br /> evere[t PUBLICWORKSDEPARTMENT WORK .IUTHORIZ[D BY THIS PERMIT MUST B[ STARTED WITHIN <br /> � 3200CedarStreet 180 DAVS OF DATE PERMIT IS ISSUED AND THEREAFTER iS TO <br /> Everet4 WA 98201 BE D�LIGENI L'i PURSUED TO COMPLETIGN. THIS PERMIT MAY BE <br /> Phone:259-8810 CANCELLED BV THE CITV UPON ANY STOPPAGE OF WORK C�N TI11S <br /> PROJECT OVER 90 DAYS DURATION. <br />