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, <br /> I <br /> i � <br /> , <br /> ; <br /> �' � � � Pu�I�c WmGs Pmmn n _ � <br /> Date�'.? �p / �� <br /> eiea.o�ni.•.—�l���-(L'�N--� <br /> Applicalion For <br /> PUBLIC WORKS PERMIT PubTOIaIFeeFco S <br /> less ApPI.Fee Peitl S <br /> Bmm�ca Duc S <br /> Print or Type Oniy <br /> 1C�Cr�A �rOLY �f' �.�C�,7 7i �A �i2�� t=✓PiA,CJ 70 �D� vVC�' y-S �S <br /> QN,�e� Mailing Address Fr � C�ty Zip Phone <br /> ��, �.�r�/� 5(o�G� ^��a ic�na� G,/� � E ������-l-f- �'j•S'1D 3 3S3 - 7l6i I <br /> Applicant Mailing Addres City Zip Phone I <br /> Describe Proposed Work �- �^���-� �--�-��— I <br /> W <br /> Prolect Address(if known) . / � <br /> Attach four(4)copies ot pluns for proposed work- Draw lo scale and nole Ihe tollowing as applicable: � <br /> • Properry Lines . • Centerline ol s�reet � <br /> • Outline and dimensions of all existin9 and • Indicate North <br /> proposed structures on the lol • Show any proposed grading changes <br /> • Exisling and proposed utilities • Show measurements M <br /> W <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> i. All.alls for inspeclion shall be made 24 hrs. In advance•phone 2S9•88�5. � <br /> 2. All work shall be perlormed in accordance with this permit and current City ol Everell Design and Conslruclion � <br /> Standards and Speci(ications. <br /> 3. Call Location Underground Service 48 hrs. betore you dig.TOLL FREE NUMBER 1•800•424-5555. � <br /> �(� �!/dL�C G�v^,P,t.S' rc�.T ����ic'�'!� <br /> ��..� O <br /> /�r/ � � <br /> � � <br /> O <br /> a <br /> ACKNOWLcDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees to hold and save harm- <br /> less the City of Everelt irom any and all claims for damages, cosls. <br /> expenses, or causes ol action Ihat may arise because ol installation <br /> and mainlenance of ihe improvement or otl�er ri9hPof-woy use hereto <br /> applied lor and turiher agrees to remove same upon notice Irom the <br /> Approved lor Construc�ion ��1e City and to replace public properry damaged thereby. <br /> FINA: INSPECTION Date pa1e <br /> Approved as Construcled Sianature of Applicant <br /> WORK AUTHOR�ZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> everett PUBLIC 6NORKS DEPAR7MENT 180 DAYS OF �ATE PERMIT IS ISSUED AND THEREAF1'ER IS T� <br /> � 3200 Cedar Street BE DILIGENTLY PURSUED TO COMPLETION.THIS PERMIi MAY 6t <br /> Everell,WA 98201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone: 259-881 S pROJECT OVER g0 DAYS DURA710N. <br /> � <br /> I <br />