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��6 sE Ya 63 -85 <br />Date <br />Applica�lon For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />�• <br />OR✓I�LE G.ToyNsoN <br />SH1RLEy ✓. ToHNSoN <br />�/G�.]� . <br />Mailing Address <br />Ci�y <br />v„oi�c wor�a nn,mn . ��' � �=J <br />Blnp Den� • <br />12 WarM�ine s <br />Totel Fne <br />«���oo� FeePnJ S <br />S 2� p0 <br />Bnlnnce Due <br />Phone <br />� I� i • r; I y� / i ' 1 <br />I / � � � . u � i l ♦ � • �I• <br />Pioiect Address lil known) <br />r% /CJ / <br />Attach lour (4) copies of plans lor proposed work � Draw to scale and note the following as applicablo: <br />• Property Lines • Centerline ol slreel <br />• Outline and dimensions of all ezrsting end • Intlicale Na�h <br />proposed struclures on the lol • Show any proposed grading changes <br />• Exisling nnd proposed utilities • Show measuremenls <br />PERMIT CONDITIONS <br />1. All calls Im inspection shall be mado 24 hrs. m advance � phone 259•8815. <br />2. All work shell be perlormed in accoiaance with Ihis permil and curreN City ol Eve�ett Deslgn and Consiruction <br />Stantlards end Specilications. <br />3. Cell Localion Underground Service 48 hrs. before you dig. TOLL FREE NUMBEP 1•800•424•5555. <br />� `-�o,r',� Tn v'F= /���,�J�" PEi� <br />i� <br />�F��,��r:»�=.�rs _ <br />.S�i�/� �� 3-r3=� <br />ACKNOWL[DGEMGNT OF CONDITIONS <br />W <br />� <br />� <br />1� <br />� <br />� <br />LJ <br />� <br />� <br />0 <br />a <br />The undeisiyned owner/appliCanl hereUy agrees �o hold and save harm� <br />-- iess Ihn Cdy ol Everelt Irom any and all claims lor Aamages. costc. <br />enpenses. or causes ot action ihat may arise hecause ol installation <br />�/�'� /�J j��/�� and maiNenance ol Ihe impwvement or olher riqht-obway use hereto <br />��� °��"'� applled lor and Iwiher agrees to remove same upon notice Irom Ihe <br />Approved lor ConsUuctlon Oale Cily and lo replace public pro r damaged Ihereby. <br />� 0� �� � � l� .� <br />FINAL INSPECTION Date '� — <br />Approvod as ConsVucted S�ynalure o� A icant D.1 <br />PUBLIC WORKS DEPARTMENT WaRK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITIIIN <br />rveret[ 1B0 DAVS OP DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />� 3200 Cedar Streel BE DILIGENTLV PURSUED TO COMPLETION. THIS PERMIT MAV BE <br />Everetl. WA 99201 GANCELLED BY iHE GTV UPON ANV STOPPAGE OF WORK ON THIS <br />Phone: 259�BH 15 PROJECT OVER 90 D 1VS DUf7ATION <br />