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i <br /> � <br /> i <br /> � �' ��] rr.nocwo.�sa�rmu • (�/ �:�� � � <br /> Date_%��' 1'! ) � / _ <br /> ApPlicaliUnFo' GmnOco�., ._ul_�`�'��[[-i /� .. <br /> P4JBLIC WORKS F�RMIT v°°��°W°��=���----- -- <br /> To�.�Fe� s_._ <br /> Less AnPI Fee PaiJ $ `_���- <br /> Aaiance Dur $ <br /> Print or Type Only <br /> �'(['�L �'�lUJ1/Ili � )"C� 1:�"� �l�-1�� !71lLkl����" `��'=.1 �� .=_�/.4-.3/�7�� <br /> Owner Mailing Address Gly 2ip Phone <br /> �vLx'.! C ol' - ,_�CG.� <br /> `�Yl �7X� _ � <br /> Applicant A7ailing�Adress City Zip phone <br /> i' �> <br /> Descrihe Proposed Work � ���L--� <br /> ,r.dC 'vUE� c"lE�°�✓%�( �Si:� la��t�(- , f �c'idEe.ri:9% <br /> , � <br /> _ � <br /> Prelect Address(il known� •� G('�� �- �/��l���i' �/�i_= � <br /> Attach four(a)copies ol plans lor proposed work- Dra�r to sc21e antl note the lollowing as applica�le: � <br /> � • Property lines • Centedine ol street /A <br /> • Outhne and dimensions ol .II eaisting and • Ir.dicale Norih V� <br /> proposetl siruclures on Ihe lot • Show ary proposed gratling changes <br /> • E�iSting zud propo5ed utilrties • Show measuremenis � <br /> 00 NOI�WRITE BELOW THIS LIN� <br /> PERMIT CONDITIONS O <br /> 7.All calls for inspection shall be made 24 hrs.in advance•phone 259•8810. � <br /> 2.All work shall be pedormed in accordance with this permit antl current City of Everetl Design and Construction <br /> St2ndards and Specificetions. <br /> 3.Call location Underyround Service 48 hrs.before you dig.TOLL FREE NUMBER 1•B00•424•5555. � <br /> O <br /> � <br /> N <br /> G <br /> a <br /> �� ACKNOWLEDGflMENT OF CON�ITIONS I <br /> � The undersigned nwner/applicant hereby agrees to hold and save ha�m- �i <br /> less the City of Everelt irom any and all claims for damac�es, costs, <br /> , , expenses, or causes ot action ihal may arise because of instnllation � <br /> _ /_'l.��� �o `ti ,_�., and mainten�nce of Ihe improvement or other righ4o4way use heretn <br /> � �/' ''� � ° applied lor and lurther agrees lo remove same upon noGce irom the <br /> qpp�rveA lor Construdi Da�e City and to replace public property tlama�ed ihereby. <br /> ���-/ ��'s� � . _R g� <br /> FINAL INSFECTION ���P ��' " .�— �n . <br /> Approved as Construc�ed Signal�re ol Applic t Date <br /> everen PUBLIC WORKS DEPARTMENT WORK AUTHORIZED BY THIS PERMIT MU.`�T BE STARTED WITHIN I <br /> � 3200CeAarStreet 180 DAYS O' DA7E PERMIT IS ISSUED AND TtIEREAFTER IS TG <br /> Evere:l,WA 99201 BE DILIGENTLV PURSUED TO COAIPLETION. THIS PERMIT MAV 8E <br /> Ph,one:259�BB10 CANCELL[D BY THE CITY UPON ANY S70PPAGE OF WORK ON THIG <br /> PROJECT OVER 90 DAYS DURATION I <br /> � <br /> � <br /> P <br /> I <br /> � <br /> I <br />