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Date � �✓ sA <br />Appllcelion For <br />PUBL.IC WORKS PERMIT <br />Print or Type Only <br />Meiling Atldress <br />21p <br />Pu�M1c Worh� Permn • �v �� _ <br />eiao oso� • <br />Puhl¢WorM�fee ! <br />Tolel Fee <br />Leet �D�� Fee P��E � <br />B�IenuOue i' <br />f3s tz�D �v2,ge <br />Deecrlbe PrOpoaed WOrk I�S7.�LG �.PA/n//lY. � P/r'�G' �uCfF,(� <br />�i�/G .E•POS�oit/ CONT•e0 L . <br />Pro�ecl Addrees pl known) NGif'/H EHS7 LO.CyTLa� c�/' /- i/[�6.r. <br />Attech lour (1) Coplee ol plane lor proposed work • Draw to acale end note Ihe lollowing es appliceble: <br />• Property Llnes <br />• Oulline end dimanslona ol all exlaling end <br />proposed elructuree on Ihe lot <br />• E�ISI1n0 end proposed ulllitlea <br />� Centerline ol atreet <br />� Indlcate Norlh <br />• Show eny pioposed Brading changee <br />� Show measurementa <br />PERMIT CONDITIONS <br />1. All celle lor Inapectlon ahelt be maJe 24 hrs. In edvence • phone 259•8810. <br />2. All work ehall be peAormad In eccordence w�th thle permlt and current City of Evarelt DesiBn end Construction <br />Stendarde end 3pacilicetlone. <br />3. Cell Locatlon Underpround Service 48 hra balore you dig. TOLL FREE NUMBER 1•800-424•5555. <br />T. CrJD.B.0 r 8E' Dlor✓� ,� ,�ijo.po✓.�O S�l"E <br />�A�/ .C79TEo /?-2i 87. <br />,S l.�JD�e�t 7b BE' Ztitq/6 P�7P L,Erl�'�e F.¢a� 3-iyi� <br />1��f�"•rin�',�/T Of F.rii'.f.ei�S' ,dATEO /^ S-'8B <br />FINAL INSPEGTION / \ �\ <br />qpproved as Constructed LJ � <br />eveiett PUBLIC WORKS DEPAPiMENT <br />� 3200CedeiStreet <br />Everet4 WA 98201 <br />Phone:258�B8f0 <br />Je�e <br />ACKNOWLEDGEMENT OF CONDITIONS <br />W <br />H <br />� <br />The undersigned owner/applicenl tereby eg�ees to hold and seve ha�m� <br />less the City ol Everell trom any and all clalms lor dameges, costs. <br />eKpen , or causes ol ection that mey arlae because ol Instella�ion <br />end ai lenance ol �he !mprovemanl or olher right•of�way use herato <br />epp ed or and lurthor agrees lo remove same upon notice Irom the <br />Cil an lo replace ryiblic property dameBed thereby. <br />�AOHK AUTHORI Y THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS O� ATE PERMIT IS ISSUED AND THEREAFTER IS i0 <br />BE DILIGENYIY PURSU�D TO COMPLETION. TNIS PERMIT MAV BE <br />CANCEILEb BV THE CITV UPON ANY STOPPAOE OF WORK ON THIS <br />PROJEGT bVER 90 DAYS DURATION. . <br />