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Date���� <br />Ap0l�calion Foi <br />PU��IC WQRKS PERMIT <br />Print or Type On!y <br />Appl¢ant Mailinc� Atltlress <br />Describe Proposed Work �i��e� <br />Project Atltlress ;11 known I <br />c�iv <br />G�y <br />Lp <br />z�� <br />Attach lou� 14) coples ol pl ms lo� proposetl work - Draw to scale anA note Ihe :ouowmg as applicable. <br />• Property Lines <br />• Outlina entl dimensians o� ell exisling and <br />proposed structure� on Ihe lot <br />• EMisling and proposed utiGties <br />•'�fJ.� Nnnf { ✓��`� <br />o�eu oeo� • __� �-a-c�+--! �_. <br />- ---- - --- <br />: ��nnc Wor�� I>e <br />toia: fae S <br />�.s�Anr� �Pe i�a�n S ___ <br />eaia,... �.�,. S <br />• Centerline ot street <br />• InAlcate Kaith <br />• Show any p�opo:,ed gramng chanqes <br />• Show measurements <br />PERMIT CONDI�IUNS <br />1. All calls for inspecti0n shall Ue made 2a hrs. m ativance • phone 259•8810. <br />2. All work shell ba pedormed m accordance with Ihis permit and wrrent Glly ol Everelt Design and Conslruction <br />Standa�ds and Specifications. <br />3. Call Lor.ation UndargrounA Servlce 48 hrs belora you dig. TOLL FREE NUMBER 1-800-421•5555. <br />/�",CC.f�.�-��e lva�:-l"� la,�t ��'l�/ .1r'�uc��.�✓ � �9� <br />S ��z• � <br />Appwved lor Consiruc�ion <br />FINAL INSPECTION <br />AUProved as C�nstructed <br />�vrrrtt PUBLIC WORKS UEPAfiTMENT <br />� 3200 Cedar Street <br />Everelt, WA 98201 <br />Phone 259�AA10 <br />ACKNOWLEDGGMENT OF CONDITIONS <br />W <br />� <br />� <br />�1 <br />� <br />� <br />O <br />� <br />� <br />O <br />a <br />Thr unUrrsiqncA own�vapplicant hereby agiees lo hold and save harm� <br />- � �ess Ihe Gry ol Eveielt trom any and all claims lor dam:�yes. cost.:. <br />— I eepenses. or tau5es ol ac'�o� that may anse because of mst311alio� <br />antl maintenance of Ihe improvement or othe� ngh�-ol-way use herelo <br />uppLed loi anA lurther aqrees lo remove same upon notir,e hom �he <br />n'��" CiIY:�r��l b ropl:icc p�bh� P���Ua�ly UnnlageA Ih�roby <br />Oate <br />Siilnalure of API`hi:anl <br />Date! -_- <br />WORK AUTHOR1ICD BV THIti PERMIT MUST BE STARIED WITHIN <br />1�0 DAYS OF DATE PERMIT IS ISSUED AND THEFE4FTER IS TO <br />BE UIUGLNTLV PURSUED TO CCMPLE710N. THIS PERMIT MAV BE <br />C4NCELLFD BV TH[ CITV UPON ANV STOPFAGE OF WORH ON THIS <br />PROJEC7 OVf.H 9p GAYS DUHATipN <br />