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�S'� - 37/ _µ <br /> . A�� �,�.f' � <br /> Cate�y_�,. �/ • ' , PoOLC Wo'hS V¢rmll�n_` , �� <br /> Appl::.ation For eia9.oeo� *—�2�LT_� <br /> iPU�3LIC W(aRK� F'�RMIT PueTotaFeeFeo $ <br /> Less ApO��Fae Paia ��— <br /> Bxiancc�uc �_ �O` <br /> Prin� or Type Only - <br /> �u--�5 /1a..., <- y0�7- c /��,,, ��� ,./��P �71" k/S" ��U��� 9�1-0/ ;�YS-32 <f� <br /> Owner Mailinq '��ess Ci�y Zip Phone <br /> ICIMC __.__ — _ _ _ <br /> Applicant Mailina •1dUress Cily Zip Pnon•� <br /> Desciibe Proposed Work ����1 ,sn•:�c� �c.�'_._ � _ <br /> _ � <br /> Prolect Addres�(il knawn) —�—J.�2 S —' � G�SOit�. � <br /> Attach lour(4)ropies of plans Wr proposad work- Draw to scale and nute ihe lollowing as applicable: � <br /> • Property Lines • Cenlerline of s��eet /A <br /> • Outlinr,and dimen=iona of a.l r.xisting zntl • Indicate North V d <br /> proposed slructuror,��n ih�:lot • Show any proposed grading changes <br /> • Exisling�n;i proc�'aed ulilities • Show measurements � <br /> DO NOT WRITE BELOW THIS LINE Q <br /> PERM�T CONDITIONS <br /> 1. All calls tor inspection shall br, made 24 hrs. iri advance- phone 2S9•881 5. eii� <br /> 2. All work shall be parformed in accordance with this permit and curreM City ol Evereit Design and Construction �y <br /> Standards and Specifications. <br /> 3. Call Loca�ion Underground Service 48 hrs. belore you dig.TOLL FREE NUMBER 1•600•424•5555. � <br /> � <br /> � <br /> � <br /> � <br /> !�Y <br /> � ACKNOWLEDGEMENT OF CONDIT�ONS <br /> �j The undersigned owner/applicant hereby agrees M hold anr save harnr <br /> - less Ihe Cily of Everell trOm any and all Glaims tor dama9es. vos�s, <br /> expenses, or causes ol action Ihat may aria � because of installation <br /> " /' �2��p and maintenance ol the improvement or other right-ot-c.�y use hereto <br /> . � -�nf/ �da� �� applied lor and furlher grees to remove same upon 'iotice irom the <br /> Approved lor Gnstr� Date CiIY and to rePlace Pub c ProPerry dam3ged iherebY. <br /> i � Q ? <br /> FINAL INSFECTION Date / ��—� __ <br /> Approved as Constructed � S��ijpn.�lure ol Applicanl Dale <br /> everett PUDLIC WORKS DEPARTMENT WU�iK AUTHORI2[D BY TH13 PERMIT MUST 8E STARTED WITHIN <br /> � 3200CedarStreet 130 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTI:R IS TO <br /> BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMII MAY BE <br /> Evere�t,WA 98201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone: 259�9815 PROJECT OVER 90 DAYS DURATION. <br />