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Date��L�� � ���,�,�. �:�.�.,�,.,,��. <br /> Applicaiion For <br /> d��,� ��_.,,� . ��"J—�����1�-- <br /> PUBLIC WORKS PERMIT °°°1o,aFao°°° g _— <br /> Lesa RO��Fee PniA �_ - <br /> Badnce Dae S <br /> Print or Type Only <br /> ^ �'� <br /> �, � ,.��� .�LI 'Ti �lnlip ,�tir= `^ ; ��a�� <br /> Ow er � Mai6ng Address City Zip Phone <br /> �r���i9��.�1�_�'-�Lol�i����;Sh ��aa� <br /> Applicant Alailmg A dress City Zip Phone <br /> Describe Proposed Work �--^ ��1 /1' 'v-■ ' <br /> ''7� I W <br /> Project Address iil known) _��� I�,� ILL`(� � <br /> Atlach lour 14)copies of plans lor p�oposeA work- Draw to scale and note Ihe lolloving as applicable: � <br /> • Property Lines • Cenler�ine of slreet � <br /> • Outline and dimensions ol all exisling and • Indicale North <br /> proposed structu:es on the lot • Show any proposed grading chanqes <br /> • Exic��ng antl froposed utilities • Show measurements � <br /> DO NOT WqITE DELOW THIS LINE O <br /> PERMIT COtJDITIONS <br /> 1. All calls for inspeclion shall be made 24 hrs. in advance� phone 259•881 5. � <br /> 2. All work shall be perlormed in accordance with�his permit and current City of Eve�^I;Design and Construclion <br /> Standards and Specilications. <br /> 3. Call Location Underground Service 48 hrs. belore you dig.TOLI FREE NUMBER 1•800•424•5555. � <br /> f�/5-87 O <br /> �vcYu� �,�.�s f'.�,��niT �u�r �,'fqc�,ef0 �_,i� <br /> � y � <br /> � <br /> � <br /> a <br /> ACKNOWLEDGLMENT OF CONDITIONS <br /> The undersigncA owner/applicaM hereby ayrees to hold and save harm� <br /> � less the City ol Everelt irom any and all c!aims lor damages. costs, <br /> eapenses, or causes ol action Ihat may arise because of ins.tal�ation <br /> and maintenance ol ihe improvement or olher right-obway us� hereto <br /> appl�ed for and luriher agrees to remove same upon notice Irom the <br /> App�oved f onstruction �a�� Ciry and to replace public property damaged thereGy. <br /> FINAL INSP[CTION Date — <br /> Approved as Consirucled Sic�nature ol Applicant Date <br /> PUBLII;WORK� DEPARTMENT WORK AUTHURIZED 8Y THIS PERMIT MUST BE STARTED WITHIN <br /> evere« 1B0 DAVS OF DATE PERMIT IS ISSUED AND THEREAFTEP IS TO <br /> � 3200 Cedar Street BE �ILIGENTLY PUR,"iU[D TO COMPLETION. THIS PERMIT M�IY 8[ <br /> �eeret�. WA �8201 CANC[LLED BY TH[ CITY UPON ANV STOPPAG[OF WORK GN THIS <br /> Nhone 25d�6815 pHOJL';70VLR 90 D�VS DURATION. <br />