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/'��'-� p VULhc Wo�As Pmmd s �� J/Z <br /> Dat�_SI�C�� c� - - <br /> Bidp Oeot � <br /> Applicat�on For <br /> PUBLIC WARKS P�RMIT P�;�s��aFoe � <br /> Leu AO�L Fea Pei� S <br /> 9�ilanroDua g ��0�-- <br /> Print or Type Only <br /> �-+�+� u1�n_ �hnln��Y lh �o? l� ��__.���Z,� �7y�-�3� <br /> Owner � Mailing Address Ciry Phone <br /> A- ' ���f- u���, I Ir '� ��1 E�Jt" ���- 4"1a3 <br /> qpplicant Mailing Address City Zip Phone <br /> Describe Proposed Work �� Q � �� <br /> W <br /> Project Address(if known) <br /> 2�30 - i�i��vc,t�E-sr ,9v� � <br /> � <br /> Attach four 14)copies of plans tor proposed work- Draw to scale and note the Icllowing as appBcable: � <br /> • Property I.ines . • Centerline of s�reet <br /> • Oulline and dimensions ol ull exisling and • Indicale North <br /> proposed str�ctures on the lot • Show any proposed grading changes <br /> • Ezisling and proposed utili:ies • Show me::surements M <br /> W <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMITCONDITIONS <br /> 1. All calls foi inspec�ion shall be made 24 hrs. in advance-phone 259•881 5. � <br /> L. All work shall be periormed m accordance with this permil and current City of Everel� DesiGn and Construction <br /> Standards anA Speciliwtions. � <br /> 3. Cah Location Underground Servica 48 hrs. before you dig.TOLL FREE NUMBER 1-800•424-5555. <br /> �! �,i1`7!�'C i(/�ul l�.E'�<�Ea�9f/ CU�e'e3 CuT f�E.c' SfA�u1lA.�'D �3U7 � <br /> 3 RE,nn✓� EXiSr�Nlr Cv.Ea' c!!i' /�'ER SF.-ci�o.✓ .3.3•� Of' THE UTy/ <br /> Of EdE•�'E7l S7/sc��F,�.c'OS h�9.rJr:-K'c. /.�.vi� �Er't.7C£ �•JiTi/ � <br /> �✓t G NE�G r'fT CL/i'h' � G-U7.'�E� . � <br /> O <br /> � <br /> ACKIJOWLEDGEMENT OF CONDITIONS <br /> The undersiqned owner/applicant hereUy agiees to hold and save iarm- <br /> — - less the City ol Everelt trom any and all claims lor damages, cosis, <br /> i expensr.s, or causes ol action that may arisa because ol installation <br /> / � � /r L�b� �f y � p 7 and mainlenance ol the improvement or olher righbo4way use hereto <br /> /1/�j ��1 l�— / U applied br and further agrees to�remove same upon notice irom the <br /> Appro�ed for Conslru qr / Date Ciry and to replace public pro�ty dama9ed thereby. <br /> i �';�i �� ��7-d'� ����-�� <br /> —�, � `�-.� -��+'7 <br /> FINAL IIQSPE ION �a,e Sig ature lo Applicar,t r Dale <br /> �pproved c�s COns�rucled <br /> WORK AUTHORIZED BY 7HIS PERMIT MUST BE STARTED WITHIN <br /> evemtt PUBLiC WORKS DEPARTMENT 780 DAYS OF DAT[ PERMIT IS ISSUED AND THEREAFTEFi IS TO <br /> � 3200 Cedar S�reet BE DILIGENTLY PUR,",UED TO COMPLETION.THIS FERMIT MAY BC <br /> Everctt,WA 98201 CANCELLED BY THE CITY UPON ANY STOPPAG[OF WORK ON THIS <br /> Phone: 259�8815 PFOJECT OVEA 90 DAYS DURATION. <br />