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r. I Puphc Wo�xs Pnmin a � /���• � <br /> C ate�_-��.�1�'�) �/ ---p—.(�-- <br /> em9.o�o� . —tS=(r(-cZ��J—"- - <br /> AnPlication For / <br /> PU �LIC VI/ORKS PERMIT `°°"°,"°„_°°` - - <br /> To1N Fec S -� <br /> Less Fno�.Fne Pain S --- <br /> � �� <br /> pnlanac Duo $ �-� <br /> Print or Type Only <br /> �M-�i � ��)M P S .�vl L l�n dG� M,_�I r_r� c�,.�L,m,�i r��9�ai Z JS�S(�j2 � L <br /> ���,�Qi- MailingAtldress City Zip Fhone <br /> ��.i.t�y ZiP Phane <br /> (,pphcant Mailing Address' Ci�.y <br /> Describe Proposed Wurk <br /> �/ nra) S ��i�1e� ,� ,l� r���-� Ldf y Ui ilr„��'u� _ <br /> W <br /> Proiect Add�ess lif knownl — <br /> �Z �3 l 5"�+ �,;� �-...I _ ~ <br /> AtlaCh :uur(4) Copies o� P�anS for propos::d work� Dra�n� to scale and no�e ihe fcllowing as apolicable: � <br /> O Propeity Lines • Centerline ol street �^ <br /> B Outline and dimensions of all existing and • Indir,ate Norih d� � <br /> prcposed structures on�he lot • Show any proposeA�radin� changes I <br /> • Existing and proposed uti6fies • Show measuremeMs /M <br /> W <br /> ��� DO NOT WRITF E3ElOW THIS LINE � <br /> PERMIT CONDITIONS <br /> 1.AI!calls for inspection shall be made 24 his.in advance� phone 259•8810. � <br />'i 2.All work shall be pertormed in accordance with this permit and current Ciry of Everelt Design and Construction <br /> Standards and Specifications. <br /> 3.Call Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1•500-424•5555. � <br /> � <br /> � <br /> � <br /> v <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicanl hereby agrees to hold and save harm- <br /> less the City ol Evere�t from any and all claims lor damages, cosis, <br /> expenses, or causes of aclion that may arise because of installation <br /> ��L�, /n�)�LLE //,r// ,,.L, � and mainlenance of ihe improvement or olher right-ol-way use hereto <br /> /� F� U �� applied br and further agrees to remove same upon notice Irom ihe <br /> Approved for Constr on �a1e City and �o repl ce public property damaged thereby. <br /> �i'/`L�'C/ ��/%n /f��t X ����(��i}� //��C� <br /> FINAL INSPECTIOIJ Date � �� <br /> Approaed as Constructed <br /> SignaWre of ApPlicant �Date <br /> WORK AUTHORIZED BY THIS PGRMIT MUST B'c STARTED WITHIN <br /> everetl PUBLIC WORKS UEPARTMcNT 180 DAYS OF DATE PEFMIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200C=darSireet BE DILIGENTLY PURSUED TO COMPLETION. THIS FERMIT tdAY BE <br /> Everett,WA 98201 CANCELLED BY THE CITY UPON ANY STOPPAGE Of WORI<ON THIS <br /> Phone:259�8810 PROJECT OVER 90 DAYS DURATION. <br />