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Date.�'��i�-r <br />Appllcation For <br />PU�3LIC WORKS PEkiVIIT <br />P�int or Type Only <br />� <br />� <br />Zip <br />��5' J� <br />Publit WOiI s Pa�/rmit ♦ <br />BIdVDePt.�,.j_,�� /� <br />Pu'�Ilc'Nmka F eo <br />iol+l Foa s - <br />Leas AppL Foe PaiE S- <br />e.i��« o�o s �CJ. 00 <br />%� 7S!3 <br />Phore <br />/�� � / � <br />Describe Proposed Work �--On 5�" /'uc.� J /" F'-S / vl C _ <br />Prolect Address (if known) _ � � — <br />II <br />Attach tour (4) copies of p�ans lor proposed work • Draw to scale and note the lollowing as applicable� <br />• Properry Lines • Center�ine ot slreet <br />• Outline and dimensions ol all ezisting and • Indicate Vorth <br />proposed .^,tructuras on the lot • Show any proposed prading changes <br />• Exisling and proposed u�ilities • Show measurements <br />Approved for <br />FINAL IN�PI <br />Approved as <br />evcrett <br />� <br />LI <br />PERMIT CONDITIONS <br />t. All calls for inspecti�n shall be made 24 hrs. in advance - phone 25b•881 5. <br />2. All work shall be performed in accordance with this permit and currem Cily of Everetl Design and Consiruction <br />Standardc and Specitications. <br />3. Call Location Underground Service 4B hrs. belore you di9. TOLL FREE NUMBER 1•800•424-5555. <br />�.'���r�� ���� <br />Date <br />PUBLIC WORKS DEPARTMENT <br />3200 Gedar Street <br />Everetl. WA 98201 <br />Phone:259�8815 <br />�—� <br />Date <br />� <br />O <br />H <br />� <br />O <br />a <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undersigned owner/applicaN nereby agrees lo holtl and save harm- <br />less the City ol Everen �rom any and all claims for damages, costs. <br />expen¢�es, or causes of action that may arise because of instellalion <br />and m iintenance ol the improvement or other riphFobway use herelo <br />,.�plie� lor and lurther agrees to remove same upon notice Irom the <br />City and to ieplace public property damaged ihereby. <br />� ,✓ L -�/ ' ' J J <br />SignaWre ot Applic. nt Date <br />WORK AUTHORI2ED BY THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PFRMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PUfiSUED TO COMPLETION. THIS PERMIT MA'f BE <br />CANCELLED �Y THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. � <br />♦ <br />_ <br />0 <br />--I <br />f'f <br />m <br />Hh1 <br />--I T <br />.-� -1 <br />N 2 <br />m <br />co <br />m o <br />c'� <br />-i c <br />o� <br />-i z <br />-� --I <br />`m <br />.o z <br />c <br />� _ <br />.-� .. <br />-� �n <br />< <br />O A <br />T T <br />—i m <br />m � <br />N <br />o r <br />t� m <br />c v+ <br />� N <br />z c� <br />.i m <br />D <br />A <br />� <br />2 <br />r <br />--� <br />� <br />� <br />0 <br />� <br />� <br />m <br />