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Dale��� ' �,:����.._,.,���,.,,�. p � - <br /> ui�: DPni . �� J�_�!� <br /> AnPlication For � <br /> PUBLIC WORKS PERMIT '°';��;���e`°° 5 <br /> �essnnai Geeaa�u 5 — <br /> Baiance o�� 5_ <br /> x�,�„� Print or Type Only <br /> [�J C+7 <br /> H <br /> � y v _��tee� Sn; �! o a 3 Gtle na.� ✓�,,.1, .�-�,r� n I-� 9�F�oi .,7 S 9 -/S 7S <br /> xy Owner MailingAddress City Zip Phone <br /> yxN <br /> �H.�ro �lYl P <br /> �N� Applicant Mailing Address Ctly 7ip Phom: <br /> VJ N �I �/ 1/�' <br /> '��j x� Describe Proposed Work _J_�11�.(7{L��� � �ei"U n��/ � S/IlC/P 1����'�1! � <br /> -�J C <br /> OH <br /> �°�g <br /> c�. o � <br /> � H� piel�rt Add�ess Id known� _V-1�,�—✓—�'�/Yn�y�( Q� � <br /> S`� <br /> p.� AItaU�four�4�copies of plans loi propaseA worh� Draw to swle and note the followin�as app�ica6le: � <br /> ��1 y • Pronerty Lines • Centerline of slreel ♦^ <br /> �r • OuUine and Aimonsions al all eKislmg:md • Indicate Norih V� <br /> � � pioposed structures on Ihe lot • Show any proposed gradm9 changes <br /> y • ExiSiing anA prcposed utddics • Show measuremenls M <br /> W <br /> UU NOT WRITE BELOW THIS LINC- O <br /> � PERMIT CONDITIONS <br /> . 1.All calls lor inspecticn shall he made 24 hrs.m advance�phone 259•88�0. � <br /> � 2.All work shall be peAormed in accortlance with this permi�and current City of Everelt Design and Consiruction <br /> I �� StandardsanASpecifications. <br /> 3.Call Location Untlerqround Service JB hrs.belore you dig.TOLL FBEE NUMBER 1•800•424•5555. � <br /> O <br /> I __ ^ � <br /> v� <br /> � � ,� � <br /> , ��''� (e '' � � <br /> � ���I � Q �� O <br /> �- <br /> ' a <br /> -- <br /> AGKN01h'L[DGLh46tJi OF CONDIT�ONS <br /> ' �. — — —_—_-- <br /> The untler_-�qned owneUapplicnnt I+me�y a9rees to hold and sa�e harm- <br /> Iess Ihe GIy oi Everelt Irom any and all claims for Aamayes. costs. <br /> , ex�.�nses. or causas of actlon iha� may arise because of installanon <br /> - and maintenance ol Ihe impro�ement or other ri9hl-ol�way us�� hereto <br /> apphed for and lunher agrees to remove samc upon noLce Irom Rie <br /> �pn�oved lor Cons�ruction Date City and to replace pubLc property damaged iheroLy. <br /> FINAL MSPECTION �'�0 <br /> qpproved as Consiructed Signature ol Applicant ����� <br /> WORK AUTHGRIZED BY iH15 PERMIT MUST �E STARTED WI7HIN <br /> rvrrell PUBLIC WORKS DEPAPTMENT 180 D��S OF DATE PERMIi IS �SSUED AND THEREAFTER IS TO <br /> � 3200CedarStre=t Be DILIGENTLv PURSUED TO COMPLEiION. TI�i15 PERldll IdAV 6C <br /> Evereft,WA9B201 CANCLLLf_D L'V THE CITV UPON ANY STOPPPGE nF�VOFk.ON 'HI`�, <br /> Phone:259�9810 PHOJECT OVER 90 DAVS DUf7�TION <br /> r" <br />