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. ' ' . . �. . .. .�'�' . _ - .. ..M.!4!f_� ��'� ' <br /> c:�; � : � <br /> Date . � P�o�,�wo,�sPo,m��. — c--_ <br /> '' F �wt af 3 <br /> Applicatlon For ;� � �� 7Q�/Y�j�� J'� oen� • — - <br /> PUBLIC WORKS PERMIT °°°��°w°��=�eP — <br /> Tatal�ee S <br /> � Lets(�001 Frr Van] S <br /> Balanrn pur $ — / / � <br /> Print or Type Only = <br /> � �� � <br /> � <br /> �. <br /> - . �' _�?- : <br /> Owner Mailiny Atldress � �� [�' -•- Gty Zip phon� <br /> � lal <br /> � "_ i� ` x ���� - �- / .�� .. <br /> Applicant Mading Addre55 City Zip Phone <br /> Describe Prpposetl WGrk� � ' � �� ' %'.'%�f=��- � '�r� %�%' 1 /�.�i' =�(,� -_ <br /> �r,'c:/C.'.'r_; ' 7.., ��1._. ._. �-. �.-_ <br /> W <br /> Pro�ect Address(d known) _ � � � " � � <br /> Attach low(4)copies ol plans for pioposr.d work- Draw lo scale and note ihe 'ollmving as apPlicable� � <br /> • Property Linas • Centml�ne of sireel � <br /> • Oulline and dlmensions of all exishrg and • Indicate North <br /> proUosed structures on the lot • Show any pioposed grading chanyes <br /> • [xi5ting and pioposeA i.iilities • Show mcasurements � <br /> DO NOT WRITE HEL01N TIiIS LINE O <br /> PERMIT CONDITIONS <br /> 1.All calls lo�� inspection shall 6e made 24 hrs.in advance� phone 259•8810. ^ <br /> 2.All•a�ork shall be pedcrmed in accordance with this permit and curieN City ol Eveiett Desi3n and Censtruction �� <br /> StandarAs anA Speci�ications. <br /> 3.Call location Underground Service 48 hrs.belore you dig.TOLL FREE NUMBER 1-800•424•5555. �� <br /> ' ' O <br /> �w1 <br /> _/ <br /> O <br /> a <br /> ( ACKNO\NLFDGEMENI OFCONUITIONS <br /> lhe unAers�yned mvier/applicant herehy ac�rec5 to hold and save harm- <br /> -- - ---j less the Gty of Eveiett Irom any and all claims for damayes. wsls. <br /> e*penses. or causes of action that may anse because oi installation <br /> � . � i`�„�. : %� and mamtenance of the improvement or dher riyht-of�way use heret° I <br /> /.. <br /> � — applied lor and lurlher a9rees to remove same upon notice Irom the <br /> qnp�oved lor Conslruction � ��bale City and to replace public propeity damaged thereUy. <br /> � <br /> FINi,L INSPECTION �afe � � � , � <br /> ;.ppr�ved as Constructed Signatme ol Applicant , D3te �� <br /> rvrrei� PUBLICWORHSDEPARTMENT W�RK AUTHOR72ED BY THIS PERM1IIT MUST BE STARTED WITHIN <br /> � 3200CetlarSireet 1P� DAYS OF D�TE PERMIT IS ISSUED AND THERLAFTEF IS TO <br /> Evereli.WA98201 BE DILIGENTLY PURSIIED TO COMPLETION. THIS PERMI7 MAY 8E <br /> Phone:259-8810 CANC8LLE0 BY THE CITY UPON ANY STOPPAGE OF WOFK ON THIS <br /> PROJECT OVER 90 DAYS DURATION. <br />