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_ � <br /> Date 1�i„�R7 I �„��,�w�...��„�„�,. �'��/,� — <br /> / / ' <br /> ApPlication For am�.o��i._�.�_��_ '' <br /> P'UBLIC VI/�1►RKS PERIVIIT P°b���Wo,N,Fe� -- i <br /> Tatal Fee S <br /> 1e55 Apul Fcc ParJ S_ '� <br /> ,�_(J <br /> Prini or Type Only 9i1nCnDi�� s-1C-__ — <br /> ����r. �r. ����4,. �t'11C�(� t-� �1'�':', �I1�. Ili_�'� �1—: �a`,�^-t�� �I "s:" S_'_I � - I `� <br /> Owner Mailing Address City Zip Phone <br /> ���I L'tnl� �' {����F'� ���!��� : ��'(� ��711�� �.L�s"cu�P��YI ( �_)'�i,k �-''��I�i-1 'i"��-1���','� <br /> Applicant Mail�ng Address Cit� lZip phone <br /> �� � �����,, � t <br /> DescribeProposedWork ��'1.1�� ��11� 1V �ly����l�' ��—f;;�f%?91 � Lf- ���"�i��,�' <br /> —�`—�;' �— -- <br /> ` <br /> Project Address(if knovm) ������1 I�1�� '� �- (t',�� G� F ��- � <br /> Atrach four(4) copies of plans lor proposed work- Draw to scale and note the lollowing as 3pplicable: LOT Z S � <br /> s Properiy Lines • Centerline of sVeet h�T. ViE�d �� � <br /> • Outline and dimensions ot all existiny and • Indicate Norih <br /> prouosed stn:c'��res on the lot ! Show any proposed greding changes <br /> O Exis�ing and proposed clilitirs p Show measurements � <br /> �� <br /> DO NOT WRITE BELOW THIS LINE <br /> PEI3MIT CON�ITIONS � <br /> 7. .411 calls (or inspection shall be made 'e4 i.:;. �n advance- phone 259•881 5. � <br /> 2. All work shall be performed in accordance cn�h this permit and current City of Everell Design and Construction <br /> Standards and Specificat�ons. <br /> 3. Call Location Ur�dergiound Service 48 hrs. before you dig.TOLL FREE NUMBER 1-800-424-5555. � - <br /> � I <br /> � T1�/�T-L.iNG n�Uof Dotu,JS�ce-:S /�,T.n /�.c'f/G/Gt�S � <br /> i <br /> 5 U/VE4�LIc� li[..E'a.�- �iU/7EK .�.PE NEC�/ � Cl.L'6'.�'O.tE.��- `�/-'� <br /> I <br /> lJ;�i��.�r�c0 �cc� L�.�.x C-C-�iTr2; �- � � <br /> i 'r S//��Lc hc �Eri'iLEG <br /> bf/ ii7c' •i�r'.�c.r"-,,t'T. � � <br /> � <br /> I � I <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The under;i�med owner/applican�hereby agrees to hold and save harm- <br /> � less the City of C-verett I�om any and all claims tor damapes. cosls. <br /> ;i_ � � � expenses, or causes of action that may arise because of installation <br /> {� p-� .�__ � �� c,� and mainter,ance ol ihe improvement or other righ�-of-�.vay use her=to <br /> Approvud tor Construction applied for and further agrees to remove same upon notice from Ihe <br /> Da�e City and to replace public property damaged thereby. <br /> c � � /�i c���' � <br /> FINAL WSPECT O Date �1..:'t-�-�-..__.) /..:�-��.i�ff�/�! .�. ��-�G�c�� <br /> Approved as Conslructed Signature of Applicant � � Date <br /> everett PUBLIG WO�iKS DEPAR7`A� 'NORK AUTHORIZED BY THIS'PERMIT MUST BE STARTED WITHIN <br /> � 3200 Cedar Street 100 DAYS OF DATE PERMIT IS ISSUED AND TfiEREAFTER IS TO <br /> Everelt WA 3�201 BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BG <br /> Phene: 25�J�F3R�5 GANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON ThIIS <br /> PROJECT OVER 90 DAYS DURATION. <br />