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---r <br /> r <br /> � <br /> I <br />�� ' <br /> i <br />; <br /> I <br />�' '� �, ,�j,_,� I <br /> fDate r��� Pvbi¢K'o�ks Pmmi R7l ')J� <br /> pi�fJ D��Ct . V\1--1-}��( I <br />' . ApPlica:ion For �-- �—)-- . <br /> PUBLIC WORK.S PERMIT P°°^°W°-�sF°� �. ----— --- <br /> ro,�,F« ,_ _ <br />' LessAnP� F�e Pa"� S__ ._'_' <br /> o,�,���o�� S 2n�'�-_—__ <br /> Print orTyFe Only ----- <br /> � <br /> „�?';�He�� I� �cU C�l rra!'� �l i,C.d ��-t�IC�; � <br />� Own Mailing Adtlress Ci1y 2ip Phone <br /> i <br />� Apphcant D'a����9 A�dress CitY LP Phone i <br /> Describe Proposed Work _ _���_�1^ `�-� ( '�TC r- 1 [.L l -i�J 1 )�� �� �II <br /> _ '__ _. � <br /> Prolect Address(il known� 7 7 ZY ` S� V/c. w� � <br /> Atl2ch iow(41 copies of plans lor proposed work - Dra�e to scale and note the fol�owing as apPlicable: � <br /> • Property Lines • Centerlin� of s�reet ' /w i <br /> • Outline and dimensicn5 of all exis'.mc�and • Irdicate Norih V, <br /> proposed strucWres on ihc•lot • Show eny proposed grading changes i <br /> • Existing and proposed utild�es • Show measurements � �,. <br /> �� <br /> DO NOT WRITE BEIOW THIS LINE �� <br /> PERMITCONDITIONS O �� <br /> i.All calls for inspection shall be made 24 hrs.in advance-phone 259•8810. � � <br /> 2.All work shall be perlormed in accordance with this permit and current City of Everetl Design and Construction I <br /> StanCards and Specitications. , <br /> 3.Call Location Underground Service 48 hrs.betre you dig.TOLL FREE NUMBER 1-800•424•5555. � ��' <br /> i <br /> O � <br /> � I <br /> � <br /> O i <br /> �� i <br /> �p� ACKNOWLEDUEMENT OF CONDITIONS <br /> r V� The undersigned owner/apPlicant hereUy agrees to hold and save harm- <br /> less the Cily of Everell from any and all claims for tlamages. costs. <br /> � - eapenses, or causes of aclion Ihat may arise because of installation <br /> � , ` >., / C" .J j and mamtenance of ihe improvement or other nght�ol�way use herefo <br /> —� �`� ��� ��" � � applied lor and luriher agrees to remove same upon notice Irom the <br /> App�oved for Cons�ruction Ds:c City and tn replace puUlic property damac�ed �hereby. <br /> �� �'��� ��// . <br /> FINAL INSPECTION Date �5..�,L�_`� � l�7/��l <br /> Approved as ConstructeG Si9�tilGre 61 Ap�lic'nt� � D� te <br /> averelt PUBLIC WORKS DEPARTMENT WORK AUTHORIZED 9Y THIS PERMIT MUST BE STPRTED INITHIN <br /> � 3200GedarSireet 180 DAYS OF DATE PER�91T IS ISSUED AND THERLAFTER IS TO <br /> Evere�t.VdA99201 BE DIUG[NTIY PURSUED TO COMPLETION. THIS PERMIT PdAY BE <br /> Phone:259-8810 CANCELLED 81'THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> P�^.OJECT OVER 90 DAYS DURATION. <br />