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����_��� ,�,.�,���„��,,.,��,,,�,,. 8 7-393 <br /> o��t_�. „ <br /> maa o�Pi.• -� <br /> npplication For <br /> PUBLIC WORKS P�RMlT PubtiCWmbFea -- - <br /> Totnlino g— <br /> I..u,>P�I.Pa+PnJ S._—�— <br /> n,i.,���o�0 5 — 2o Q' <br /> Print cr Type Only <br /> �� �l.V��� f ���> ��2� /�.��`�'�i i ({A.� ���?� '7�3 -�Z�� <br /> O ner Mailinq Addiess iry Zip Phone <br /> �1�}' �j�1'� 5�4V11r�� <br /> Applicant Mailing Address Clty Zip Phone <br /> Describe Proposed Wurk ���L]L-!=' — — --�-- <br /> � W <br /> Project Add�ess�if known) 3�0 2 � — UQ�A'UL� /9!/E. � <br /> Atlach lour 14�copies d plans lor pr�nnsed work� Draw to scale and note Ihe lollowing as applic2ble: � <br /> • Properry Lines • Centerline ol slreet � <br /> • Outline and dimensions of al'existin9 and • Indicate North <br /> propused structures on the lol • Show any Uroposed grading changes <br /> • Existing and proposea utilities • Show measureme.�ts M <br /> W <br /> DO NOT WRITE BEIOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 1. All calls for inspection shall be made 24 hrs. in advance- phone 259-881 5. � <br /> 2. All work shall be perlormed in ac.cordance with ihis permil and current Cily of Everelt Design and Coosiruction <br /> Stand•ards and Specilica�ions. <br /> 3. Call Location Underground Service 4B hr, Uelore you dig.TOLL FREE NUMESER 1-800•424-5555. � <br /> � <br /> � <br /> � <br /> � <br /> a <br /> `\ ACKNi,' �DG �.MENTOf CONDI�IONS <br /> IDi.r <br /> !Y(� The undersiqned owr •.�li�anl hereDy agrees lo hold�nA seve hann- <br /> V less the Cib� oi Eve� �n any and all claims tor damn�,ies, costs. <br /> , enpenses, o' cause � �tion iha� may arise because of inst211ation <br /> • L' anC mainte�.arre o' � improvcment cr other nc�hFof-way use iiereto <br /> �l/� flY�/�i ypplied for ;nd lurtii�� arees lo removE same upnn notice Irom Ihe <br /> qpproved tor Constru� / Date City and to 'eplc�e p,:�� aroperty d�maged thereby. <br /> FINALt SPECTION � � �/`��Date �=���—�— � �7— <br /> ?,pproved as Constructed Signatu�r .p �can Date <br /> WORf; °'!!.t?� 'LEG 3}' THIS PERMIT AIUST 8E ST.�.RTED WITh'IN <br /> everet: PUBLIC WOFI<S DEPARIMENT 1B0 i�4YS ..- '�ATE PEFMIT IS ISSUED ANJ THEREAFTER IS TC <br /> � 3200 Cedar Slreet BE Dil IGE�d-'_Y PURSULD TO COMPLETION.TI'iS PGRAIIT MAY BE <br /> Everelt,WA 98201 CANf i L!.EC 3Y'�'HE CITY UPON ANY STOPPAG[OF\VORK ON THIS <br /> Phune: 259�8615 PROJPCf �;Lr �+0 DA�S ['URATION. l <br />