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Date_l_L�0� �� � �,.�,��, �:�,...,��..,mQ��.'] ���]� <br /> mm� fr:n� • —.fl-1-���Sl'1 --- <br /> APPGca�io.. ror <br /> PUBLIC WORKS PERMIT �"°°°W°""°° ---- - - - <br /> ,�„���� S- <br /> lnssAnni (nrPa�aS_ — <br /> palanrrr Dw S <br /> Print or Type Only <br /> ��-�c��,� at�� � a I,�-rncx� �'� �rett� ► <br /> Owner Madmg Atldross City 7 n Phone <br /> APPIiGan� <br /> Maihng Atldmss Gry Zip Phone <br /> r" _ J 1 1 't-' _ <br /> Descnbc Proposed Work --���=� <br /> W <br /> Pro�ect Address lif knownl � � <br /> � <br /> Attach four(41 coples ol plans for proposed work- Draw to scale and note Ihe lollowing as applicable: � <br /> • Property Lines • Cenleiline ol streel <br /> • Oulline anC dimensions ol all eaislmg and • Indicate North <br /> oroposed structures on the lot • Shcw any proposed grading changes <br /> • Existm9 and proposed utildies • Show measurements M <br /> W <br /> DO NOT WRITE BELOW THIS LINE O <br /> PEHMIT CONDITIONS � <br /> 1.AII calls for inspection shall be made 24 hrs.in advance-phone 259•8810. <br /> 2.All work shall be performetl in eccordance with this permit and current City of Evere�'Design and Co�struction <br /> Stentlards and Specifications. � <br /> 3.Call Location Underground Senice 48 hrs.betore you dig.TOLL FREE NUMBER 1•EI00-424•5555. <br /> r�-L�� ���-,r'�('ep � <br /> ���L !7'� <br /> i `��"`��_gy N <br /> � 0 <br /> � <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The unAersigned owner/applicant hereby agrees to hold and save harm� <br /> less Ihe Cily ol Everelt Irom any and all claims lor damages. costs. <br /> expenses, or causes ol action ihat may arise because ol installation <br /> and inamtenunce of ihe improvement or other right-ot�way use herato <br /> apphed lor and furthe� aqrees to remove same upon notice Iwm the <br /> Approved lor ConslruUion Date City a��d to replace public properry damagetl Ihereby. <br /> FINAL INSPECTION �`��� — Date <br /> Approvetl as Constructed Signature of ApnlicaN <br /> WORK �UTHORIZC-D BY THIS PERMIT MUST BE STARTED WITHIN <br /> everett PUBLIGWORKSDEPARTMENT 1y0 DAYS OF DATE PERMIT IS ISSUEO AND THEREAFTER IS TO <br /> �� 3200 Cedar Street 8E DILIG[NTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Evereit.WA 98201 CANCELLED BY THE CITY UPON ANY STCPPAGE OF WORK ON THIS <br /> Phone:259�8810 PROJECT OVER 90 DHVS DURATION. <br />