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., b�u�✓� <br /> �a�� � /�� Publm Norh�Po���� <br /> L <br /> Bitlg DePI.+_� <br /> Application For <br /> pUB�IC �VORKS PERMIT P�OTOIaFceFee � <br /> lesx Pppl.Fee Paid S �— <br /> 00 <br /> Bal�.nceDue S�n�- <br /> print or Type Only <br /> ^ <br /> �.s�¢�Q.., ��r.��_r�' / �'�16�rr�'��C��-t�' ��� �'� , � o 'S�•���� <br /> wner Mailing Address City ip Phone <br /> �_ <br /> � ��'"'�_� Phone <br /> Applir,ant Mailing Address City ZiP <br /> Describe Propos�d Work ��i� <br /> W <br /> _ � � ca-f« /2C>c?j— /5�'—'s " � F � <br /> Project Address(if known� <br /> Attach tour�4)copies of plans for proposed work- Draw to scale and note the lullowing as applicable: � <br /> • Propert) Lines O Centerline of streel � <br /> • Outline and dimensions ol a�l exisling and Y Indicale Norih <br /> proposed slructures on the lut r Show d�y proposed grading chanyes <br /> ! Existing and proposed ulilities • Show measuremeMs � <br /> ��` DO NOT WFITE BELOW THIS LINE A <br /> PER�11T CONDITIONS �✓ <br /> 1. All calls for inspec�ion shall 6e made 2S hrs. in advance- phone 2S9•881 5. � <br /> 2. ��11 work shall 6e perlormed in accordance with this permil and current City of Everetl Design and Construc�ior <br /> S�andards ard Specifica�ions. <br /> 3. Call Lncation Underground Service 48 hrs. before you dig.TOLL FREE NUMHER 1-800•424-5555. � <br /> O <br /> � <br /> � <br /> ►, W <br /> '�� <br /> �� <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicaN hereGy agrees to hold and saee harm- <br /> — less the City of �vere�t from any and all claims for damages, costs, <br /> expenses, or causes of action Ihat may arise because of installation <br /> % -� � /� .� and maintenance o( tl�e improvement or other righFol�way use herelo <br /> ��� G�7�'+�'�•�"-i � �'� `��� applied for and furiher agree., to remove same upon notice irom ihe <br /> Approved for'� tructiq Date City and to replace public property damaged ihereby. <br /> ii � Z(���� , <br /> PINAL INSPECTIUN Date — <br /> Approved as Conslructed SignaWre of Applicant Date <br /> WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> ecerett PUBLIC WORi(S DEPARTMENT 730 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER I� TO <br /> � 3200 Cedar Street BE DILIGENTLY PUHSUED TO COMPLETION. THIS PERMIT MAY 9E <br /> Everelt,WA 98201 CANCELLED BY THE CITY UFJN ANY STOPPAGE OF WGRK ON THIS <br /> Phone: 259�8815 PROJECT OVER 90 DAYS DUR�.TION. <br />