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� q� <br />� <br />>HN <br />y <br />H N <br />�2 C7 <br />� � � <br />N <br />� <br />� ri <br />O 1-i <br />n <br />Q�C] <br />ry� <br />�y N <br />A�W <br />� O � <br />I�� <br />�/�� /, TO POSTING_._ a a� I�- <br />Dnte_1�����/ <br />qpplicalion Fnr <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />c ��� <br />n��e�,c wor . r.�m�i . _. <br />� �•l <br />Oltlp Oel`I • _fJ� <br />run��c wo�., rne 5 <br />,o,,, «� <br />inar enm r.n vn�n S — <br />n,�,�.�. o�. s 2O'_ --- <br />` Ci�y -- ZiP--- pha�e � i �" <br />„_,,,,,,,,,,� Maihng Atldress _ � , <br />Desc�i6a ProDosed Wo�k <br />Proiect Address lil knownl <br />Allsch lour ld) �opies ol pinns lor pwposed wo�k � Draw lo stale and note� C^^�1°�`"'�e ol shee�cabie <br />• ProDerty Lines • Indicate North <br />• Oulhne nnd dimnns�ons u� all eaishn9 and � 5����� ��Y �roposed qrading changes <br />proposed 51rucNreS on Ihe h� � Show measurements <br />• E�istmg an0 proposed utifitles <br />PERMIT COND�TIONS <br />1. All calle for Inspection shell be made 2< hre. in advance � phone 259•881 O. <br />2. All wOrk shatl be pertormed in eccordance with lhis Oermil and current City d Gerett Design ard Construction <br />Stendards and Specificetions. <br />3. Cell Locetion Undergraund Service 48 hrs. be�ore you d�g TOLL FREE NUMBER 1•800-424•555 . <br />4 BYYTHEAPUBLIC WORKSRIN PECTORT MUST BE APPROVSD <br />S.CANNRCT DOWNSPOUTS TO PUBLIC DRAINAGE SYSTfiM. <br />B.RSSP CITY STRHF.TS CLSAN AT ALL TIMES. <br />7 TOYTHH SATISFACTIONUOF THB PUALICLW RKSLDSPTREPAIRED <br />� <br />�iVj�-�Qx_ �j-1—�O <br />Approvetl lor Consiryclion Oale <br />`� . <br />/.: ; <br />�li, �A.����� � / —� —Datr <br />, <br />FlIJAL INSPECTION <br />ppproved as Conslrucla0 <br />��i.���� PUBIIGWOAKSD.:PAR11dEN7 <br />� 9200 r.eelar Slreel <br />Ever� It. WA 98201 <br />Pho'ie� 759-E3N10 <br />ACKNOWLEOGEM[Nl OF CL'JDI110N5 <br />W <br />H <br />� <br />� <br />� <br />O <br />The unde�signetl owner/apPlicanl hae6y �9�ees lo huld and s�rvc harm� <br />�ess Ihc Cdy ol Evcrell Irom �ny and all clalms Im tlmm�qes. cosls. <br />e�penses. or causes o� a<tion Iha� may anse her.aiise nl inslallation <br />and mamtenante ol thc unPwvemenl nr olhcr n9PPobwaY �isr nereto <br />�pphed �or anA Wrihei ag�r,es lo �emove same unon notice ��um Ihe <br />Cdy a��d to rep�ace P����hc P�oPe��y damayed Ihe�ehy. <br />_ _�Sr�LI._ <br />Dale <br />niynn�uic.�� ..r.r...�..... <br />WORK AUTHOR17LD I3� ����5 PFRMIT MUST BE STARTED W�THIN <br />IBO DAY:i OF DATF ^F.RMI7 IS ISSUED AND THFREAPTEfl IS TO <br />B[ DILIGFNTLV PUFSUED 10 COMPLRION THIS P[RMIT 61AY B[ <br />CANCELLE[) OY TH[ CITY UPON ANV 570PP�GE Of WOf:K ON T��1S <br />PROJCGT OVEH 90 D�YS DURATION <br />