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------___ y,� i_.<<� - :� ,- s,.�/ <br /> /' � Pu01ic Woiks Permit• I���� <br /> ,� S 97 ` � - . -�--• <br /> Date � ' eiao.oeci. �����' <br /> ApplicaUon For <br /> WORKS PERMIT PueGcwoixaFea S__ <br /> PU BLIC 7p101"� <br /> Lese ApO��Fca PaiO S �� <br /> Balnnce Oun <br /> S ��— <br /> Print or Type Only <br /> � �, ae�3 <br /> Mailing Address Cily � <br /> ZiP Phone <br /> wner <br /> Ci1y ZiP Phone <br /> qpplicenl Mailing Address <br /> Describe Proposed Work <br /> I � <br /> - W <br /> .,, -� I- <br /> Pro�ect Address(if known) � <br /> Attach four(4)copies ol plans for proposed work• Draw to scale and note�C o1ieW�ne of streyi`able: � <br /> � property Lines • Indicate North <br /> � Outiine and dimensions of all existing and � Show any proposed grading changes � <br /> proposed structures on the lot � Show measurements <br /> • Existing and proposed ufilities O <br /> DO NOT WRITE BEIOW THIS LINE <br /> PERMIT CONOITIONS � <br /> 1. All calls for inspection shall be made 24 hrs. in advance•Phone 259'8815. <br /> 2. All work shall be Perlormed In accordance with this permit and current Cily of Everelt�esign and Construction � <br /> Standards end Specifications <br /> � 3. Call Loceliun Und�rground Service 48 hrs.before you dig.TOLL FREE NUMBER 1'800•424•555 . <br /> , sc��T e7PES NoT f�/°v� O <br /> /� <v T / �?f/i,� �� � � <br /> ��.,q� � t c�T � f,LY" �c co.ED�0.� � <br /> ,CcC'„Qc_ ,�cC'c��S '7c'I ",." z`_S'f��S/6'itiTy <br /> �f aS/��ai3_ ir is v�...v�✓c.�.s � iA <br /> T.� �'7�/.J L c Gil�1C G�3�E o.� i9 fi�.E'T�-aJ �r` Lo i O <br /> � �� ��`r ia N�� G�i�'�A��c <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned ownedapplicant hereby agrees to hold and save harm- <br /> less the City ol Everetl Irom any and a�ar se becauseaofa9 stallatfon <br /> expenses, or causes ol action thal maY <br /> � and maintenance of Ihe improvemenl or other righhot-way use hereto <br /> e� � applied for and further agrees lo remove same upon notice Irom the <br /> - � - ate Cily and lo repla�blic property damo9ed therebY. <br /> � qp edforCo ru � � �' ��_.> ; � <br /> / i ll/ _J�' 'y-' :V,. -� �> c.��.� �/ � <br /> Date --Y—� � / 6te <br /> FINAL INSPECTION $IgnafGre ol Applicant <br /> ApprovedasConstructed y�(7RK AUTHORIZED BY THIS PERMIT MUST BE STARTED W�THIN <br /> everelt PUBLIC WORKS DEPARTMENT gEODI�LIGENTLY PURSUED TO�COMPLETION.DTH SEPERMIT A1AY BOE <br /> � 3200 Cedar Streel _ <br /> Everelt,WA 98201 PROJECT OVER 90 DAYS DUR T ON.STOPPAGE OF WORK ON THI <br /> Phone: 259•8815 <br />