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��� <br /> A�x <br /> C H <br /> 9H [n <br /> H <br /> H N <br /> �� � I (�"� ��,.�,���v,o,�,P�.m��j <br /> o x o Date . , , � o2�7b <br /> y y~ ._- � -.._--- --- <br /> einn o�.0 • - - -� <br /> APPIif:tliOn FOf <br /> �z PUBLIC WORKS PERMIT "��°°°`°°"„�° <br /> o ,o,.,�Fe� s <br /> OM � . , ....� r,„,v.�n5_ —_. <br /> ��g ;,. . � , , s --__— <br /> �" n Print or Type Only <br /> H <br /> x>y <br /> r�'1HH �`MLD�.�\ I�J�% — <br /> V N �"� Ownei / Idailing Atltlress GIl, Zip Phone <br /> C'!Cp7 f/� <br /> �[sJ t" �l LL _ _-___-.—_ -- — — <br /> [+1 <br /> y 0� ppplicant Mailing Add�ess Cih� Zip Phnnc <br /> Describe Proposetl Work �1.L{'-L-Yl-lv��-'�`�� � <br /> Ti�1�' l�7 C`-.�f�'_�.vJ..l l I <br /> Pralecl Add�ess lil knownl <br /> a�� i �.��-tz�o� � � r-�� �, <br /> Attach fow�A�copies o�Plans lor Praposed work�Draw to scale and note Ihe foilowing as apPlic�6lc � <br /> • Property Lines • Cenlerlme of slreel <br /> • Out�ine and dimensions ol all ex�sting and • Inditate North <br /> proposea slruc�ures on Ihe lot • Show any nronosed giadmq changes <br /> • Existing and Proposed utildies • Show measuremenis /M <br /> W <br /> '�1 DO NOT WRI7E BELOW THIS LINE O <br /> 1�' PERMIT CONDITIONS <br /> 1.All calls for inspection shall be made 24 hrs.in advance�phone 259•8810. � <br /> '�t 2.All work shall be pedormed in accordance with this permit and current City ol Everelt Design and Construction <br /> Standa:ds and Specilications. <br /> ' ' 3.Gall Loca�ion Underground Service A8 hrs.belore you dig.TOLL FREE NUMBEFi 1•800•424-5555. � <br /> O <br /> i j ���� �f��h� � i'�LT f���Ui���J� <br /> . ,_ � <br /> �-� I��� i�i` (� O <br /> ►- I �� � - �"i <br /> �_� G' <br /> _ � <br /> '� ACKNOVJLEDGEMENT OF CONOITIONS <br /> 1�' The undersi9ned o�ner/applicanl herel>y agrees to hold.nd save harm- <br /> Iess ihe City ol Everelt Irom any and all claims lor damages. cosis. <br /> - � e•penses. or causes ol aciion Ihat may anse be-ause of installation <br /> and maintenance ol ihe m�provement or other right�of�way use herelo <br /> applied lor and luriher ac�ree5 to rCmove same upon notice Irom �he <br /> Approved for Construclion ���� Cily and to replace public property damaged Ihereby. <br /> FINAL INS�ECTION Datc p��i, <br /> Approved as Constructed Sinnature of APplicant <br /> WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WItHIN <br /> i.�.���i� PUBIIGWOFKSDEPARTMENT 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAPIER IS TO <br /> � 3200CedarStreet BE DILIGENTLV PURSUED TO COMPLETION. THIS PERM�T L1AV Bc <br /> Eveietl WA 99201 CANCELLED BV THE CITY UPON ANY STOPPAGE OF WCRK ON iHIS <br /> Phone:259�8810 PROJECT OVER 90 D�VS DUR�710N. <br />