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I �� <br />Date � � $ <br />Ap�lication For <br />;.'.; ��,�,I� WQRKS PERMIT <br />Print or Type Only <br />Sa w�.Q- <br />qpNlicant <br />� <br />Address �'�Y <br />Describe Proposed Work <br />r1r��A� rns ��������—�„v,,,i� M <br />PubLc Works Permi� a <br />,�8-387 <br />aiee.00ai., g'�.�LO/'�� <br />p�ttic wo�xs Fee $ <br />TomlFee — <br />Loss ROo�� Fec PaiO $ /��-- <br />Ba�anceDua $ <br />Phone <br />�// ...5%- �eri fD` %77�[-G( L{�i.�y_ <br />Pmject Adtlress (if known) �- <br />AUach low (4) copies ot plars for proposed work - Draw to scale and note.�Ceoterline of str�ee�c�ble: <br />� property Lines • Indicate Norih <br />i Outline and dimensions ol all ezisting and � Show any proposed grading changes <br />. proposed strudures on ihe lot � Show measuremen�s <br />• Existing and proposed utilities - <br />PERMIT CONDITIONS <br />1, All calis for inspection shall be made 24 hrs. in advance - phone 259•8810. <br />2. All work shall be pedormed in accordance with this permi[ and current City of Everelt �esign and Conslruc:ien <br />Standards and Specificaticns. <br />3. Call Location Underground Service 48 hrs. before you diS� TOLL FREE NUMBER 1•800•424'S55 . <br />� � � �a-7.�..- � f c �c�-�-� � . "z�r�� <br />��N.. c�� 9-/� -.98 ����� <br />everett PUBLIC WORKS DEPART: 9ENT <br />� 3200 Cedar Street <br />Everelt, WA 98207 <br />Phone: 259-8810 <br />� <br />!� <br />� <br />l-iJ <br />� <br />O <br />ACKNOWLEDGEMENT OF CGNDITIONS <br />The undersigned owner/applicant hereby agrees to hold and s�ve harm- <br />less Ihe Ciry of Evereu iiom any and oll claims lor damages. costs. <br />expenses, or causes of action that may arise because of insta!lation <br />and ir.ainlenance of the improvement or olher right-ol �.vay use hereto <br />applied�9 r and turther agrees to remcve same upon notice from the <br />Ciry apfl/o replace p)+blic pmperry damaged �hereby. <br />— ZL—d� <br />�itli�u�... <br />WOR AUTHORIZED� Y THIS PERMIT MU:iT BE STARTED <br />1B0 AYS OF DAT PERMIT IS ISSUED AND THEREAFTER 15 TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY B[ <br />CANCELLED 6Y THE CITV UF'ON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />