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DatB�s v�mrcwoa.vsf,,,n�. ��i���' <br /> Application For eieu oeo�+ Cr���3�— <br /> PUBLIC WORKS PERMIT P°°ro,:FeeFee s <br /> le�e�ppl Fee PeiC S <br /> Print or Type Only e.�.��.o�a S 2�D� <br /> �cus oHlr� ..%/_��. 1r�C�s� Ev�.tz��l"�r�/�:: �ocfY�r��-,�e:�- �•a:.?o� 3s3"-S/�/sz. <br /> Owner Mailing Address Cit� Zip Phone <br /> �OUI^1C,� _ � <br /> Applicant Meiling Address City 2�p Phone � <br /> Describe Proposed Work ��57�L �s/ �/'�`� `�]NC��fj�' �/Vl=2tI/gy <br /> — r+ rr <br /> y �*i <br /> '/ W " � <br /> � <br /> Prolect Address(il known) _ ���'!�EKQG Eit/h dU�lf S,/,�J. �nT JZZ (�(s/2�l ERY.�(?5J/�'� L �` <br /> Attech four 14)copies ot plens lor propused work- Draw to scale and note the lollowing as applicable: � � � <br /> • Property Lir,es • Centedine ol street <br /> • Oulline end dimensions oi nll r,xisting and • Ind�,:ate Norih <br /> proposed structures on lhe lot • Show any proposed giading changes � H <br /> • Existing and proposed utililies • Show measurementc �Q Z <br /> L'7 NOT WRITE BELOW THIS LINE O � � <br /> PERMIT CONDITIONS <br /> 1. All calls lor inspection she�l be•nsde 24 hrs. in advance-phone 259•881 5. � � � <br /> 2. All work shall be perlormetl iu acco�dance with ihis permit and current City of Everelt Design and Constmr,�ion y <br /> Standards and Specifications. � N <br /> J. Call Location Underground Seivice 48 hrs.belore you dig.TOLL FREE NUMBER 1•B00•424•5555. � <br /> � �� <br /> � n <br /> /�� ' ,b�' <br /> V♦ � <br /> O � <br /> a � <br /> H('� <br /> h] <br /> ACKNOK'LEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees to hold and save harm� <br /> less Ihe City of EveiEd hom any and all tlaims lor damages, costs, <br /> iJ 7 expenses, or causes of action tha� may arise because ol in�tallation <br /> •��s` ��9¢��� ���gs and maintenance o� �he im novement or olher righbobway use he�:�to <br /> Approved for � tlon � ate applied for and lurther agr.�es to re�r �ve same upon notice Irom the <br /> / Cit -anBt replace publi property c ��=d thereby. <br /> FiNAL INSPECTION � � Date! -<<, � �-- /—a%—O r <br /> Approved as Ccnstructed S�g ture ol Applican �ate <br /> everett PUBLIC 1NORKS DC-PARTMEt�T RK AUTHORIZED BY THIS PEtiM1T MU�T BE STARTED WITIiIN <br /> � 3200CeAar5lreet �80 DAYS OF �ATE PERMIT IS ISSUED AND THEFEAFTER IS TO <br /> CvPrett,WA gg201 BE DILIGENTLY PUHSUED TO COMPLETION. THIS PERMIT M11AY BE <br /> Pl�one: 259�BH15 CANC[LLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 50 DAVS DURATION. <br />