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Date_��� �� <br />qpplication For <br />E �Y��V CQO��� ■ ����� <br />Print er Type Only <br />�I� <br />Owner <br />App��caN <br />�; f <br />Ivtailin� Address <br />City <br />ly <br />,c <- / -35� <br />` <br />Puelic Waiks Perepy�+�/ �—r-r�— <br />amc noai.. � --- X`30 <br />Pu�im Warks Fao S — <br />Tulel Fea <br />Le:s Appl Fee Pa�tl $—� '' O� <br />F3:iance Duo � —=� <br />�G 3G � <br />�i� 3ss-�vsz <br />ZiP Phone <br />�;,, Phone <br />N579tc ds' u�r d� �a�u — <br />Describe Proposed WorK .L-- <br />7'.�"c�,� - <br />Project Address (if known) _ — - <br />�h <br />Attach lour (4) copies of plans lor proposed work - Draw lo scale and nole the lollowing as applicable: <br />• property Lines <br />p Outline and dimensions o! ��I ;•xieting and <br />;,roposed structures on the lot <br />O lixisting and proposed utilities <br />m Centerlin� ot street <br />• Indicate �Jorih <br />• Show any proposed 9rading changes <br />v Show measurements <br />PERMlT CON�ITIONS <br />1. All calls for inspection shall be made 24 hrs. in advance - phone 259•8815. _ <br />2. All work shall be perlormed in accordance with this permit and current City of Evere�t Des�.9n �nd Construction <br />Standards and Specificalions. <br />3. Call Location Undergro�ind Service d8 hre Geiore vou dig. TOLL FREE NUMBER 1-80U•424-55 •• <br />.J �%' c7'3. <br />Dale <br />Approved for <br />��'��-�- <br />Dale <br />FINAL WSF'tl:i�vrv \` \ <br />Aoproved as Constructed � <br />I cverett PUBLIC NlOR`CS DEPARTM <br />I � 3200 Cedar Sl�eet <br />Fveretl. WA 9P.201 <br />Phone�. 259�881 i <br />� <br />'� <br />M; <br />ACVWOWLEDGEMENT OF GONDiTIONS <br />The undeislgned owner/applicanl hereby agrees la hald and save harn- <br />less Ihe Ciry of Everell fwm any and all claims for dama9es, cosi;. <br />expenses, or causes of actinn lhat may arise because of installation <br />and maintenance of ihe improvement or ather righPof�way use hereto <br />rpP11e�..,r�n�re.o�lace'uuGl c�proPe�oyrdamaged thereby.n notice froin !he <br />5=/��5� <br />Sig wre oi ,.i,N���p,�� <br />HK AUTHORIZED BY THIS PERMIT MUS7 BE STARTED WITHIN <br />8C DA'fS OF DATE PERMIT IS ISSUED AND THEAE-AFTF.R IS TO <br />BE UiLIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELI.LD C3Y THE GTY UPON ANV STOPPAGE OF WORK ON THIS <br />PROJF_CT OVER 50 UAYS DUFATIOiJ. <br />0 <br />--i <br />m <br />... .. <br />�� <br />.-. -i <br />v� x <br />m <br />C o <br />mc <br />r. <br />--i c_ <br />o � <br />�, <br />_-I � <br />m <br />O < <br />c <br />a —� <br />r s <br />- � <br />< <br />� <br />O D <br />3 <br />� fTt <br />x <br />m .- <br />N <br />O <br />or <br />c-� m <br />C N <br />3 � <br />m <br />z c� <br />-i r <br />. m <br />z <br />