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Date lo l0 91 <br />Appliwtion For <br />PUBLIC WORKS <br />Print or T� pe Only <br />George P. Bacon 22606 - 91st W <br />TO i'OSTING � " %-7 `'� PuohcWorhaParma� ��``Y / <br />Biop �eo�. •4�2��d <br />i <br />P E�i M I T P°D�¢ WOtA6 FCa <br />ieial Fee s — <br />1 <br />Less Auo�� Fec Peid S_ <br />' � - ��aianca Due S <br />�.'S �n <br />� O fl �' � It-i r', <br />- ��� �� , „ <br />Edmonds. ,-, WA ;`;; 98026 ' ., 778-0875 <br />Mailing Address � � ' �, -. � � ,.. CiIY . � - �� . � ;LP -. Phone <br />Owner .' r�, Li c� �_- - : In . � c �. � � �-_ � �. <br />�:-i c.-� F. o . c � -��i .. _ ' � m - � �� � <br />r_� • o• =:r �i� �� or. u.� ,., �; ; � <br />'n. _'2 3' .. <br />oi'inei � � <br />Applicanl Mailing Atldrass Ciry ZiP Phone <br />3-� �; f <br />Describe Proposed Work Cbnstruct new 4�eeit aot blda <br />Prolec[ Address (if known) <br />Attach four (4) copies of plans for proposed work - Draw to scale and no�e the following as applicable: <br />• Property Lines • Centerline of sireet <br />• Outllne and dimensions ol all existing and • Indicate North <br />proposed structures on the lot • Show any proposed grading changes <br />• Existing and proposed utilities • Show measuremen�s <br />PERMIT CONDITIONS <br />1. All calls for inspection sheil be mede 24 hrs. in advance - phone 259•8810. <br />2. All work shell be performed in accordance with this permit and current City of Everelt Design and Construction <br />Standards end Specifications. <br />3. Calt Location Underground Service 48 hrs. betore you dig. TOLL FREE NUMBER 1•800-424•5555. <br />(� �i .� /i ^ / <br />/� ,��CC. .L:.[<i�.tcE.✓ Ontq� /.c"Ga�r-n� .�[.a� c�lt✓ �.F•2 <br />/ <br />n��.,,. Cc���n,r� ���/1-1 c(�.bz/i�- �,�,� mv /-23�- 9l <br />/r /['i�� !c LL 2d-/�'d'� <br />L <br />� � ���r���— i 2s� y-� <br />Approve bT COnsiruction Date <br />� � �� �,�� /i <br />r� <br />FI AL INSPECTION <br />Approved as Constructed <br />�Ar�PUBLIC WORKS DEPA9TMENT <br />3200 Cedar Street <br />Everelt. WA 98201 <br />Phone:259-8810 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />W <br />H <br />� <br />� <br />� <br />O <br />� <br />� <br />O <br />a <br />The �ndersigned ownedapplicant hereby agrees to hold and save harm- <br />less the City ol Everetl irom any and all claims tor damages. .:osts, <br />expenses. or causes o� aclion Ihat may arise because of instal�alion <br />and main�enance ol the improvement or olher right-ol�way use hereto <br />applied br and further agrees to remove same upon notice lrom ihe <br />City an to replace public property damaged ihereby. <br />�///� ��• �,-, <br />Sig ture ol A plicant Date <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUEO AND THEREAFTER IS TO <br />BE DILIGF.NTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOI'PAGE OF W(1RK ON THIS <br />PROJECT OVER 90 DAYS DUR�TION. <br />