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�s � <br /> t � <br /> ; <br /> i <br />� ! <br /> f � , <br />, '� <br /> i I <br />�I I <br /> � ! <br /> � <br /> , <br /> Date�a -�1 ,��-,�-� <br /> Put�Iv,Ylorw�Pa��' aiy--�, r^ <br /> Applir.ation For Ai�o oeN • _�_.�_�1[ 1 �_ � <br /> PUBLIC W7RKS PERMIT ;'"—�,^°��:°��s��------ ' <br /> ,��,�F�.� s_ <br /> i.�•ssnon� FrrPai� S � � <br /> e:,i,�«.o��, 5 >�-�OC �� .., <br /> Print or 7ype Only <br /> �����i����,�i,���� � 'r�stl�l�I� ����� �,� I►�� n ��ivc� ���� �� <br /> Owner Maiiing�tldress Ci�y Lp Phone , <br /> _ �_/�� /�� ��7—X���� � "1� <br /> Applicanf Mailing Address City Zi Phone I � �, ,�� <br /> �. <br /> Describe Proposed Work ���+�' �( / f`���� `-� � 1�-�� <br /> i'rojec[Addresslif known) _ ��-j� •� �/�•`"���� ���Z/ _ � <br /> � <br /> Attach four(4) copies ol plans for proposr.d work- Draw to scale and note ihe following as apP��cable: � <br /> • Propeny Lines • Cen�eriine of streel � <br /> • Outline and dimensions ot all exicling and • Indicate North � <br /> proposetl structures on the lot • Show any proposed grading changes <br /> • Ewsting and proposed utili!�es • Show measurements � <br /> � DO NOT WRITF BE�OW THIS LWE O I <br /> PERMIT CONDITIONS <br /> 1.All calls for inspection shall be made 24 hrs.in advance-phone 259-8810. � <br /> 2,All work shall be peAormed in acwrdance with this permit and current City of Everelt Oesign and Construction <br /> Standards and Specifications. <br /> 3.Call Location Under9round Service 4II hrs.before ycu dig.TOLL FREE NUMBEfi 1-800•424-5555. � <br /> � <br /> � <br /> � <br /> O <br /> a - <br /> ; <br /> ,�I ACKNOWLE�iGEMENT OF CONDITIONS � <br /> �j�W The undersigned owneVapplicant hereby a9rees to hold and save harm- <br /> less the Clty of Everell from any and all claims for damac�es, cosls. <br /> 1 / . expenses, or causes of action tha� may nrise because of installation <br /> ���,j,_� /.. �J_ 1 . ' ' and mainlenance of the improvement or other right-ol�way use herelo <br /> �—�!./_" _. iI'."i'- _ 7 -,�7%� � <br /> ' applied lor and furiher a9rees to remove same upon notice irom thc . <br /> Approved lor Consiruction Date Cify and to replace public proper�y dama9ed ihereby. �I <br /> ��/G��— �'���` i <br /> � II <br /> FINAL INSPECTION Date �-- � <br /> Approved as Constructed Sign re 1 AUPlicant � D te <br /> everetl PUBLICWORKSDEPARTMENT WORK �UTHORIZED BY THIS PERMIT MUST BE STARTGD WITHIN <br /> � 3200CetlarStreet 190 DAYS OF DATE PERMIT IS ISSUED ANU THEREAFTER IS TO <br /> Everetl,WA98201 BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMiT MAY BE <br /> Fhone:259�8810 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PFOJ[CT OVER 90 DA'IS DURATION. <br />