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�_L� ' _ <br /> osi� �,,�,�,�w�,,,,�•�,�,�- —�_____. <br /> �i�— <br /> � Piaq Dro� • �—��� <br /> (�nn�IC(1�.Jf1 �Df <br /> PUBLIC WARKS PERMeT ru�ioieiFooreo $ <br /> �a�• n,ni rea vs�a 5 <br /> 9alenceUuo S <br /> Print or 1'ype Only <br /> _ 'i11i � � ��i7r � =�%Y� , '�!l��' �%;il�rii�J ( rrf �-�1� � lY'-' � I <br /> Owner � ' Mailing Address / Cily 2ip Phone <br /> �' <br /> �/' <br /> ppplicanl Mailing Address Cily Zip Phone <br /> Describe PrnP�sed Work � �� � �LF� ��� � f � � ���C ��'--�� ��f�� <br /> W <br /> Project Address Iff knownl � �����1� �/ ��� '1�'� -- � <br /> Altach low(4)copies of plans lor proposed work- Draw�o scale and nole lhe tollowing as appiicable: � <br /> • Property lines • Genterline ol slreel � <br /> • Oulline a�d dimensions ot �11 existing and • Inrficate North <br /> proposed structures on Ihe��t • Show any proposetl grading changes <br /> • Existinp ano propc�eA ulifities • Show measurements � <br /> DO NOT\NR17E BELOW THIS LINE � <br /> PERMIT CO�J�TIONS <br /> 1. All calls lor inspection shall be m�de 24 hrs. in advance- phone 259•881 5. � <br /> 2. All worM.shell be perbrmed in accordance wilh this permit and current Ci�y ol Everett Design and Construction <br /> Standards ono Specilications. <br /> 3. Call Locallon Underground Service 48 hrs. be!oro you dig.TOLL FREE NUMBER 1•800•424•5555. � <br /> �l/�S'G!G (-rJe.e.CS �F%'/riT /I/OT �({-qUi/�F,O �'/S-<97 O <br /> ��7� �� <br /> V♦ <br /> O <br /> a <br /> ACKNOWLEDGEMENT OF CONDIT�JNS <br /> The undersigned owner/applicaM hereby agrees to hold and save harm- <br /> - less Ihe Ciry ol Everelt Irom any and all claims lor damages, costs, <br /> expenses. or causes of action that may arise because ot installation <br /> and mainfenance ot the improvement or o�her righl-ol-way use hereb <br /> applied tor and luriher agrees to remove same upon notice Irom lhe <br /> 4pproved for Construction Date Cily and to replace public propeiry damaged Ihereby. <br /> FINAL INSPECTION Date Date <br /> Approved as Construded Signature of Applicant <br /> WORK AUTf10RIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> evcretl PUBLIC WORKS DEPARTMENT 7�p DAYS OF DATE PERMIT IS ISSUED AND THEREAFTEP IS TO <br /> � 3200 Cedar Street BE OILIGENTLY PURSUED TO COMPLETION. THIS PERMIT tdAY BE <br /> Evmelt.WA 90207 CANCCLLED BY THE GITY UPON ANY STOPPAGE OF WORI:ON THIS <br /> Phone: 259-E815 PROJECT OVER 90 �/1Y5 DURATION. <br />