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� � i � � Pu1�Lc Wo�haPe�m��i __--. . <br /> Date�.2,L17./90 ' eiao o�oi .�/_2612� — <br /> � � Application for <br /> PUBLIC WORKS PERMIT °°°T�,'vF�a"° S <br /> N <br /> C� M L�•ssRnp�.�cePaJ 5 <br /> b �3 N <br /> N {C � na6,�cc0uo S _ <br /> 7 <br /> � y � Print or Type Only <br /> �p N ro <br /> N M <br /> `� x � Margaret Thomson 15323 – 41st Ave SE Bothell 98012 phone <br /> O � Qw��� Mailing Address C'�Y Z�p <br /> � n � ggZp� 252-3688 <br /> �>> —Av�---�'� Phcae <br /> H <br /> z y � ��1 T 8�—BVQS�Mailing ddress ���Y Z�P <br /> � � <br /> Applican� <br /> Fi N <br /> y Tenant ' <br /> ~ D�scri�e Proposed Work <br /> C N <br /> � c� r <br /> � � N W <br /> Proiect Address(il known) 2118 EveYet — � <br /> � <br /> Attach four 14)copies o�plans�or proposed work� Omw to scale and note the lollowing as applicable: � <br /> • Pronerty Lines • CeNerline ol street <br /> • Indicate Norih <br /> • Oulline and dimensions ol all ex�sting and � Show any proposed gradin� cnanges <br /> proposed s�rucWres on�he lo� � g����y ipeasuremenis /� <br /> • Existing and nroposed utilities W <br /> DO NOT WRITE BELOW TNIS LINE O <br /> PERMIT GONDITIONS � <br /> �-- t,All wlls lor inspection shall be made 24 hrs.in advance•phone 259•88�0. <br /> � 2.All work shall 6e pedormed in accordance with�his permit and curreM City ol Everelt Design and Construction <br /> ( C��� Standards and Specilications. � <br /> 3.Call Location Under�round Service 48 hrs.before you dig.TOLL FREE NUMBER 1•800•424•5555. <br /> 1 / / . /' � ��}/� � � <br /> ^ n p '1. � L/1 <br /> ��� J�!,�/ q. ��2�htt� /L(^( �if�,�[���u, <br /> ���� ( G�Cf,.-Ld� IO�'i./>r��. �� �(./GC <br /> r �w <br /> I — _I <br /> O <br /> _�_� a <br /> 4 '�� ACKNOWLEDGEMENT OF CONDITIONS <br /> �� The andersigned owner/aPPlicant hercUy ag�ees to hold and savc haim- <br /> �� �---- le5s Ihe City ol Everelt ��om any and all claims lor damoyes, cosls. <br /> � expense: or causes of action ihat may arise Uecause ol insWllallon <br /> ' and mamtenance of lhe improvement or other ri�hl�ol-way use hereto <br /> �'—' apPlicd for and furlher aprees to remove s&me upon notice Irom ihe <br /> Approved br Construclion Date City and to replace public property dama9ed Ihereby. <br /> FINAL INSPEC710N Dale Datc <br /> Sic�nature ol App6cant <br /> AppmvedasConstwcted WORK AUTHURIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> Oevcrett PUBLICWORKSDEPARTMENT 1B0 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> 3200 Cedar Street BE DILIGENTI_Y PURSUED TO COMPLETION.THIS PERMIT MAY BE <br /> Evercu,WA98201 CANCELLED�Y 7HE CITY UPON ANY STOPPAGE OF 1NORK ON THIS <br /> Phone:259�8810 PROJECT OVEP 90 DAYS DURATION. <br />