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Date-14�L 91 ,wr <br />Application t� r <br />PUBLIC WORKS <br />Print or Type Only <br />KURISA & FERGUSS <br />Owner <br />JON�S CONSTRUCTION <br />Applicant <br />Describa Proposed Work ._ TI <br />project Address (il known) _is <br />IPu�l4 Wnrxi Pxun�t • <br />pii'r,eiaQ.oeou 91%2$046 <br />1 <br />P E R Ni I T P�bbc Warka Fea s <br />Toul Fes <br />Leaa ROGI Fee VaiE S <br />Balanca oue S — <br />MT LK <br />City <br />City <br />Attach four (4) copies of plans for proposed work • Draw to scaie and note� Ceniterline of shee�cable: <br />• Property Lines • Indicate North <br />• Outline and dimansions of all existing and � Show any proposed greding changes <br />proposed structures on the tot � ghow measurements <br />• Existing and propused utiliti�s <br />�l <br />PERMIT CONDITIONS <br />1, All calls for Inspection shell be made 24 hrs. in advance- phone 259•8810. <br />2. All work shall be performed �n accordance with this pnrmit and curtent City of Everntt Design and Construction <br />Stendards and Specffications <br />3. Call Location Underground Servlce 48 hrs Uetora you dig. TOLL FREE NUMBER 1�800�4245555. <br />�C' �J�.�.G� LUC7i��-r %�Llr� v� / ve'i /�G , <br />O <br />�� <br />/G' _�/-�� <br />.� � . <br />Approved for Constructlon � ' . � Date _ <br />FIN!\L INSPECTION . �2te <br />Approved es Constructed <br />/I�� PUP,LIC: WORKS DEPARTMENT <br />' 32C0 Cedar Street <br />� Everelt WA BA20' <br />� Phons:^5&88�7 <br />W <br />H <br />�w <br />�� <br />� <br />C <br />�► <br />J <br />� <br />� <br />ACKhOWLEDGEMENTOFCONDITIONS � <br />The undersigned owner/applicant hereby agr:�es to ho;d and seve harm- <br />less tho Ciry of Everett from any and all cleims-tor damages, costa <br />expens�s, or causes of action that may arise because of instaliation <br />and rrtiiNenance ot lho improvement or other right•of•way use hereto <br />applied !cr and lurther aorees to remove same upon notice £rom the <br />Clry and to replaca pc�!ic property damaged thereby. <br />Date <br />Signalure ot Applicant <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OFDATE PERMIT IS ISSUEU %,ND THEREAFTER IS �TC <br />BE DILIGENTLY FU9SUED TO COMPLETIJN. THIS PERMIT MAY BE <br />CANCELLEO BY YHE CITY UPON ANY STOPPAGE OF WORK ON THI£ <br />PROJECT Ol'ER 90 DAYS DURATION. � .. <br />