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Date \/ <br />ApplicallOn For <br />PUBLIC WORKS PERMIT <br />Print or Type Only �'�"/ �` g � <br />FUDbcWeMPnm��• _ <br />B�ap o.m . <br />Pu01K WY��� IN <br />Tel�lfe� { <br />Lo��00�fMP�E f <br />e.a�<.o�. s <br />Plan Chack Nos 8 40171 sBPl1 <br />Owner �pp11ut.DSYat 04 07 93 Z�p Ppone <br />Job Addrasu 67 1 ORC11N <br />Own�rt C1IRLSON 1tEN <br />Tnnantt <br />Propoted U�at SINCLB FAMILY R6SIUENCS <br />Applicant DY�C. of WOikt Z�P P�one <br />CAIUGE 6 HOUSE AIIDN <br />Desc�ibe Pr000seE WorM . OFPICB SET JOB SET <br />— APPROVED FOR PERNITt DATE_/_/_ BY_ � <br />Projecl Atltlress (il known) <br />dtteth lour (4� Copies ol plens lor ptopoSeE work • Oraw Io Scale anE nate I�e I011owinB as appliw )le: <br />• Pmperty Llnes • Centetline ol 5lreet <br />• O�tline anE Aimensions oi all existing anG • Intlicate Norlh <br />O�oposeE slruc�ures on Ihe lol • Show eny praposeC graEing c�enges <br />• Exi5linB an0 Proposed ulililies •$�ow measuremenl5 <br />PERMIT CONDITIONS <br />t. All calls lor Inapection shall be matle 24 hrs in edvance- pnone 259•BB1 O. <br />2. All work a�all be perlormed In eccordxnca wit� t�is permit and current City ot Everelt Des10� entl Constructlon <br />StunOaWs end Specitiwllons <br />3. Call Locetion UnOergrountl Service 4B nrs. belore you di0� TOLL FHEE NUMBER 1•800�424•5555. <br />PUBLIC WOFiKS PENMIT <br />NOT REOUIREO <br />i� <br />BY 'f�--'� --- <br />0 �T F �1 - �'�==-- <br />lOr Consimction <br />FINAL INOPECTION Date <br />AppfovCA TS COn51ruCICd <br />�PU�LICWOPKSDEPARTMENT <br />3:00 CeEar Slreet <br />Evcre�4 �Y�198201 <br />P�one:259�BB70 <br />ACKNOWLEDGEMENT OF rnNDITIONS <br />ZI <br />O <br />H <br />�/ <br />O <br />a <br />Thc uneersigned owner/a001icanl hereby agree5 �o hold and Save harm� <br />less ihe Ci1y ol Everetl lrom eny and atl claims lor Aamnges, costa. <br />expenses. or causes ol action I�at may arise Eecau6e ol inslalletion <br />end mainlenance ol Ihe impmvemenl or other riB���a��M'ay uso herelo <br />applied lof and Iurlher aprees Io remove Same �pon noiite Irom Ue <br />Ciiy anE to rep�ace public praperty tlamaged ��orehy. <br />Sipnature ol ApPlicant Dale <br />WORK AUTMORIZED BY TMIS PERMIT MUST BE STARTEO WITHIN <br />190 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY f'URSUED TO COMPLETION. THIS PERMIT MAV BE <br />CANCELLED BV TME CITY UPON ANV STOPPAGE OF WORK ON TNIS <br />PROJECT OVER 90 DAYS OURATION. <br />