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�atE�.l1�Z�f` <br />Apulicalwn For <br />PUB�IC VVt�JRKS PERMIT <br />Print or Type Only <br />Owner <br />(�'�c.�'C7/ �/1fltC- C///%y E-:I�G,FC','i <br />iling Address City <br />� j ,. <br />Puolic Wa�ks Parmit • <br />B�dq. Dao�� � �� � L � <br />Pubfic Worke Fee � <br />iotat Fee <br />Lesa A00�� Fee Pe�d $ — <br />i� <br />Balence Due � .—`��� � �'"� <br />����g � <br />',f«Xj .�SS y tjSZ- <br />Zip phone <br />��������� Nailing Address City 2ip Phone <br />Applicant <br />Nc��c� 3S"' Cdi�J� rC�h,«��c � D��vr'e��Fl� <br />Describe Proposed Work � <br />��— �f /i _.,-_.. �J-r�.:�r. _ <br />Projeat Address (if kncwn) <br />— 7 "�' c�r .: '� <br />Attach four (4� copies of plans tor proposed work - Draw to scale and note ihe lollowing as applicable: <br />• Property Lines <br />• Outline and dimensions ol all exis�ing and <br />proposed structures on the lot <br />• Existing and proposed utili�iea <br />•'.P <br />• Centerline of ,tree' <br />• Indicate North <br />i Show any proposed gradin3 chan9es <br />• Show measuremenis <br />LI <br />PEIiMIT CONDITIONS <br />1. All calls tor inspection shall 6e made 24 hra. in advance - phone 259-8815. <br />2. ..II work shall be Fertormed in accordance wilh ihis permit and current Ciry ol Everet; Desic�n and Cnrstni�.tion <br />St�ndards and Specitir,ations. <br />3. Call Lo�ation Underc�round Servir.e 48 hrs. betore you dig. TOLL FREE NUM1IBER 1-800•424-5555. <br />. .[ c-l� . 1 .. <br />�il. ��. Y" y�� � <br />y � <br />✓ l � �, / ���"-, <br />Approved for Construction Dote <br />� - �'G:� �'`�_ /'i <br />J/� f:11:'i��".lz�,�.;�e::•fi� .3-/u-�� <br />FINAL INSPECTION � � �ate <br />Approved as Constructed <br />evemtt PUFUC WORKS DEPARTMENT <br />3200 Cedar Street <br />Gverett. WA 98201 <br />Phone�.259-8815 <br />ACKNOWLEDGEPdENT Or CONDITIONS <br />The untlersic,7ned owner/applicant herehy agrees to hold and save harm� <br />less �he City of Everelt Irom any and all claims for damagec, cost:� <br />expenses, or causes of action that may arise because o1 installation <br />and maintenance ot ihe improvement or o�her rigM�of-way use herelo <br />ypp!ieC �or and turiher agrees to remove same upon notice from lhe <br />City an o replace public properry damaged Ihe�eby. <br />� �c�,�.— �.��- g y <br />Signa�u-- r��icant � Date <br />✓ <br />WORK AU�!iO�iZED BY THIS P�RMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT I;; ISSUED AND THEREAFTER IS T� <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERP.IIT t.tAV BE <br />CANCELLED BY ThIE CITY UPON A(vY STOPPAGE OF VJORK ON l HIS <br />PROJFCT OVER 90 DAYS 7URATION. <br />C <br />� <br />r. <br />c <br />H V— <br />a � ' <br />� � <br />�i <br />r- r <br />C7 '" <br />a ( <br />G :: <br />'.T..' �i-. <br />;7 <br />F <br />b : <br />� ;. <br />�' ` <br />� c <br />0- <br />a�. <br />� <br />�. <br />4' <br />