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Dale�, ,,/ p� �,✓ <br /> v�mer.worksvmmn• _C")/ ' /3� <br /> ���� � — <br /> �ma oca�.•—• t ' <br /> AppliCation Fo� <br /> PUBLIC WORKS P�RMIT r ,ToaFenFQe S <br /> Lesa nnn��Fen Vam S <br /> BNnnca Duo � � <br /> Prinl or Type Only <br /> 1��1 �11i��ti'���=n' �rr�� i� `rni�ti��.�inl r=�!��� �7��1�3_ _ ,a?�'1-�l`7oZ3 <br /> Owner Mailing Address Cily Zip Phone <br /> 1�� �r(`/tl`,7i�'1 '"T1(� f - �/)1� <br /> Applicant Mailing Address Ciry Zip Phone <br /> Describe Proposed Work �I��F"l�� � ��—/t <br /> _ W <br /> Prolect Addiess(if known) ��� ��02 — GiE�dGf' " T- A Cc>TS o/' � <br /> /1,ti- 4'S <br /> Attach four(4) copies ol plans fo�proposed work� Draw to scale and note the lo�lowing as applicable: � <br /> • Property Lines • Centerline of sireet � <br /> • Ou�line anA dimonsions ot all existing and • Indicate Norlh <br /> proposed structures on Ihe lot • Show any proposed grading changes <br /> • Exis�ing and proposed utilities • Show measurements � <br /> DO IJOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> t. All calis for inspeclion shall be made 24 hrs. in advance- phone 259•881 5. � <br /> 2 All work shall be performed in accordance with lhis permil and curren�City ot Everett Des.gn and Consiruclion <br /> Standards and Specilications. <br /> 3. Cail Location Underground Service 4d hrs. belore you dig. TOLL FREE NUMBER 1•S00•424•5555. � <br /> O <br /> �p <br /> _/ <br /> O <br /> � a <br /> � ACKNO'JJI.EDGEMENT OF GOIdD1Tl0�� <br /> � The undersignetl Gwner/applicant hereby 2grees fo hr r save ha�m- <br /> -- less the City of Everelt Irom any and all claims ic ��- �ages, coste, <br /> expenses, or wuses of ac�ion ihat may arise bec: � �f installalion <br /> �_ ` � / �. i jl 3— � _� and maintenance of ihe improvement or other right-�. way use hcreto <br /> �, ly�Z"�4 applied lor and lurther agreea to remove same upon notice irom lhe <br /> Approved lor Con r ion �' ,/ Date City and to�eplace public p 6perty damayed thereby. <br /> ! y�;,��i-j _��� j J 1f <br /> FINAL IN PECTION Dale � 1�'F � �-I �'��� ' r � <br /> Approved as ConsLucted Sig aturc of Appl�t , Date <br /> evrretl PUBLIC WORKS DEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE STAflTED WITHIN <br /> 180 DAYS OF DAT[ PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200 Cedar Street BE DILIGENTLY PURSUED TO C061PLETION. THIS PERMIT MAY BE <br /> Evereti.WA 98201 CANCFLLED BY T.HE CITY UPON AIJV STOPPAGE OF WORK ON THIS <br /> Phonr.: 259�B�i3 gqOC� PROJECT OVEF 90 DAYS OURATION. <br />