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Dale t�_in_91 TQ PQJI�NG �„��_��c:-.,��...,�. � `ib6' /' <br /> ' Ap0licalion For —_��� �'�a o<m..�<.Q218 <br /> PUBLIC WO�iKS PERMIT �°°;�;:,;:.° : -- <br /> Leu�00�FeePbE S <br /> - au.�c�o�e 5���_ <br /> Print or Type Only � � ' - - <br /> �', <br /> STUART DRE6HORN 2114 47TI{ ST , EVERETT 98203 252-2635 <br /> Owner MailingAtldress �;. Cpy . . Zip PhOne <br /> ` ri : <br /> - i i,i <br /> OWNER 'r,' _` `.,� . �.� � � <br /> App�itant M�ilingAtldress City Zip P�onc <br /> Describe Proposed Work ��DITION _ <br /> � <br /> Prolect Addreas(il known) � <br /> Altach law�4)COpieS oi plan5�0�propOsetl v.ork�Draw ta snle nntl nnle I�e lolicwing as applicnble: � <br /> •PmOerly Lines •Cenlerline uf slreet � <br /> •Oulline an0 Jimension,ol nll oxisting antl •Intli:ale Nort� <br /> pmposed slrucNres an I�e lot • Show any propased gradinq chan9es <br /> •ERisting an�Oroposed ulilitms •S�m�i measuremenls � <br /> DO NOT WRITE BELOW THIS LINE � <br /> PERM1IIT CONDITIONS <br /> 1.All calls lor inspection shall be made 24 hrs.in edvance-phone 259•8810. � <br /> 2.All work shall 6e perlormed in occorCance wit�this permit ane current Ci�y ol Evomll�esign an�Cons'ruction <br /> SlanCarCs and Specilicailons. <br /> 3.CaIILocationUndergmundServite4Bhrs.beloreyoudig.TOLLFflEENUMBEfl1•800•424•5555. S <br /> i <br /> � <br /> (�� <br /> Vd <br /> � <br /> � <br /> ,� ACKNOIVLEDGE61fNT OF CONDITIONS <br /> T�e undcrsi9ne4 cwr.r�p'cDohwnt hmeby ayrens Io hoitl antl save harm� <br /> Iess ihe City ot Everelt imm any and all claims lor tlamages. cosls <br /> // C%pClISCS. 0!CdO5C5 O�dC�1011 �113� Illd}' 01ISP, bCCdCSC 0� IpSld�lpli0� <br /> [�"(. ' ,� � an0 mumtenance ol Ihe i�npmvemen�or olher nqhPol�way usc herelo <br /> L.K' � ap0lietl lor antl lur�ner aprees �o renove same unon notrce Imm Rir <br /> APUwvetl lor ConSiruc � Dale Ciiy and lo replace public property tlamaged ihereby. <br /> - a,t�_ y� � 3/�3 Z <br /> FINAL INSPECTIO Date <br /> Approved as Consimctetl Si9nature ol ApPGcant �al!• <br /> �A� PUBLICWORKSOEPAflTMENT WORK AUTHORIZED BV THIS RMIT MUST BE SiARTED WITHIN <br /> 3200Catlar51rce1 180 DAYS OF DATL PERMIT IS ISSUED AND THEREAFTER IS TO <br /> EvereU.WA98201 AE DILIGENTLY PURSUED TO COh1PLETION.THI$PERh1R IdAV DE <br /> CANCELLED BY THE CITY UPON ANV STOPPAGE OF WORK OI.iH15 <br /> P4one:25B�B810 PROJECT OVEP 90 DAVS DURATION. <br /> J <br />