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tir <br /> Date�y I hElicWo�k�Perm11+ v � � <br /> B�Eq.Dapl.• <br /> Applicatlon For <br /> PUBLIC WORKS PERMIT "°°"`"'°�.F°° <br /> To�ei Fae s—�� <br /> Lese ApO�Fae P�iE _���� <br /> B�I�nce Due s �0 �y�R��— <br /> Print or Type Only <br /> �C N A C. Rp 6IIJSo rJ 2.o I 4�C-�PJah1D �U ere iC" 9��b Z.S�.n 14`t7 <br /> Owner MeiNng Address ���Y <br /> � d �„����EQ-s �60� 1-r�[�Ev� ,v�a�,Ysv�l.(.� 4S.�7o �s9-9si,� <br /> AppHcant <br /> MailinB Address City Zip Phone <br /> 1 �-,_ _ r� � ��: �� S�a(� In �'ronT <br /> Describe Proposed Work 'r'� P (8�-� a �U N�.�� T ��—�� �r-'� — <br /> �2 � <br /> - W <br /> Pro�ect Address(il known) � <br /> � <br /> Attech four(4) coples of plans tor proposed work• Draw lo scale and note the following es applicable: � <br /> • PropeAY Lines • Centerline of street <br /> • Outlfna and dimensions of all ezisting and � Indicate Nurth <br /> proposed atructures on the lot • Show any proposed grading changes <br /> • Existing end proposad utilities � Show;neasurements M <br /> W <br /> DO NOT WRIT BELOW THIS LINE O <br /> PERMIT CONDITIONS � <br /> 1. All calls tor inspectlon shall be made 24 hrs in advance- phone 259•881 5. <br /> 2. All work shall be performed in accordence with this permit and cuirent City of Everetl Design and Construction <br /> Standarda end SpecNications. � <br /> 3. Call location Undergrou�d Service 48 hrs. before you dig.TOLL FREE NUMBER 1-800•424•5555. <br /> '�E -� � � cTlv� �a�� �.v � r -/'�j O <br /> �� m � .�vM �s r� 2 -� �' <br /> � <br /> � <br /> a <br /> y �,/�� ACKNOWLEDGEMENT OF CONDITIONS <br /> �' F �. <br /> The undersigned owner/applicant hereby agrees to hold and save harm- <br /> less the City of Everelt from any and all claims for damages, costs, <br /> �'//�� expenses, or causes of action Ihat may arise because of installetion <br /> c���e6 p z ��7 and main!enance of ihe improvement or other ri9ht-of-waY use herelo <br /> -f�y applied �or and further agrees lo remove seme upon notice Irom the <br /> � Approved tor Const uction � �� Dale ��� ynd to replace ublic pro erty dameged thereby. <br /> �-/� f 7Jo- •l�-�.l�+-� �/z-l�7 <br /> � � �/ / �/i'/ � •01l-�7 �� / <br /> INAL INSPECTION Date Date <br /> Approved es Constructed <br /> Signahire of APPIi nt <br /> WORK AUTFIORIZED BY THIS PERMIT MUST BE STARTED <br /> everett PUBLIC WORKS DEPARTMENT 180 OAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200 Ceder Street BE DILIGENTLY PURSUED TO COMPL°TION. THIS PERMIT MAY AE <br /> Everett.WA 98207 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone:259•8815 PROJECT OVER 90 DAYS DURATION. <br />