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Date�J-��9 �—, � �„„�,,:wo,h,P.�m��. r <br /> APPlicniinn i ... taina Deoi . ..�� _Z 7�[1_ .. <br /> ��' _— <br /> . PUBLIC WORKS PERMIT ��°��;o;;�p;.`°° s-- --- -- <br /> �.sennmr««va:�t5 ___ <br /> r.am�..�w� S <br /> Print or Type Only = <br /> /�l�Pr7�:Q/� /Da, N� ,2�3 Sf S b�f1P �l�/dS' 3(03 /�JPS! <br /> Ownei MadinU�ddress Cdy 2ip Phone <br /> qppl�canf Madmg Adtiress Cdy Z�p Phone <br /> Desc��b� Proposed Work � ��� Q.�—�JS�p(-�7f�_T'�-QQ.r�2�� Gn� <br /> G rOr� �r���.,_„� rrn �� <br /> Prolect AdCress lil knownl ���vs-V�Gtr� � <br /> � <br /> Attach lour 14)copies o�plans lor proposed wo�k� Draw tn sr.aie anA nole Ihe Inllowing as apPlicable�. � <br /> • Property Lmes • Cen�erhne of streel � <br /> • Outline and dlmensions of all exishng and • Indicate North <br /> proPosetl structures on the lot • Show any proPoseA grading changes <br /> • ExiStmg and propo5ed utilltirs • Show measurements � <br /> DO NOT WRITF BELOW THIS LINE O . <br /> PERMIT CONDiTIONS <br /> 1.All calls for inspection shall be made 24 hrs.in advance•phone 25�8810. � <br /> 2.Atl work shall be peAormed in accordance with this permit and current City of Everetl Design and Construction <br /> Standerds and Specilications. <br /> 3.Call Lxation Underground Service 48 hrs.before you dig.TOLL FREE NUMBEN 1•800-424-5555. � <br /> ����c C�Yz/i��„�sc ( �L���'�,��,.c,t,;o/� O <br /> ..�t����-c-%== � <br /> n'/,9-�'� � � <br /> O <br /> a <br /> �CKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/appllcant hereby agrees to hold and save ha�m� <br /> -- � less Ihe City ol Everelt Irom any and all claims lor damages, cos�s. <br /> r.zpenses. or causes ot aclion that may anse because ol inslallatron <br /> and maintenance of the improvement or other righbol-way use hereto <br /> — — aPplied lor and further agrees to remove same uGon notice Irom the <br /> Approved lor Constructlon Date Cdy and to replace pubhc property damaged thereby. <br /> FINAL INSPEC710N Date <br /> Approved as Constructed Signatuie ol Applicant Date <br /> WORK AUTHORI2ED BY THIS PERMIT MUST BE STARTED WITHIN <br /> everett PUBLICWORKSDEPARTMENT 180 DAVS OF DATE PfRtdli IS ISSUE� AND THEREAFTER IS TO <br /> � 3200CedarStreet OE DILIGENTLY PURSUED TO COMPL[TION. THIS PERMIT MAY BE <br /> Everelt.WA 98201 CANCELL[D 8V THE GITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone:259-88'0 PROJECT OVGR 90 DAYS DURATION. <br />