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�°� <br />H <br />�Hx� <br />HZ� <br />�H� <br />'���H� <br />OHb <br />�/��g <br />y�Y �] <br />t"y� <br />�yH <br />N <br />o�cn <br />�o� <br />'-i <br />� <br />Dale��90 <br />nPnlica�lon fo� <br />pUBLIC WORKS PERMIT <br />Print or Type Only <br />RE-DEL-W Const <br />APPlicanl <br />Describo PiopoSed Work <br />II <br />i�,.:..�w�nen»�mn.=����C� - <br />m.�i o�ni . _99�249Z3—_—._—_—. <br />1'i�l,�� Wi�r.f f rn <br />u,�.,i n•. S <br />i �.. enm r.. v..,n S <br />�.en��,.0��. S ��� <br />5130 Narbeck Everett 98203 348—SBoO <br />MadmgAtlAress Gty 7ip Phone <br />Mailing <br />ProloctACdressl�'knownl �c . — +^9"'"^^^' -- — <br />A��ach lour (4� cop�es ol plan5 lor propoSeA work � Drpw lo scale antl note �he �olluwm9 , 5 apphcable <br />• Proper�y L�nes <br />• Outlme and tlimensions o� xll e>rsl�n9 anA <br />proposed SVUttures on �he lol <br />• Ecisting a�d Noposed utll�hes <br />• Gantedme al strerl <br />• Intlicole Noith <br />• Show any p�onosed 9�nAmy chanyes <br />• Shmw rneaswemeNs <br />Phone <br />PF.RMIT CONDITIONS <br />1. All calis lor InsDec�lon shell 6e made 24 �ri �� aavnnce � phone 259•8810. <br />2. All work shall be pedormeJ in accordance wilh Ihis permit and curreN f�ty ol Everelt Design ai�d ConslrucUon <br />StenCerds and Specilita�ions, <br />3. Cell Laetion Underground �crvice 48 hrs. belore you dig TOLL FREE NUMBEP 1•800•424•5555. <br />4.ANY CHANGS IN THB DRIVEWAY CIIT MUST BF. APPROVED <br />BY THB POHLIC WORKS 7NSPECTOR. <br />5.CONNECT iXIWNSPOUTS TO PUBLIC DRAiNAGE SYSTEM. <br />6.KF.SP CITY STRE6TS CLRAN AT Ai�L TIMF.S. <br />7 TOYTHSMRAT7SFACTiONt'OF THR P1Ri�ICLW RRSLDSPTRF.PAIRED <br />;�-�Q yy �- � a o C9 - 2�� -�r� <br />App�oved lor Consiruclion ���e <br />�g/./s�f - ;l.,J�...7i <br />FlNAL INSPECTION Date <br />Approvetl as Consiructed <br />everrlt PUBLIC WORKS DEPi�RTMENT <br />� 3200Ceder5lreet <br />Everell. WA 98201 <br />Phone�. 259�t3�10 <br />FCKNOWLEDGLMCNT Of CONDITIONS <br />W <br />H <br />�w <br />_ / <br />� <br />O <br />/�� <br />V♦ <br />O <br />a <br />The undersiyned owner/�PPlmant hereUy acJiees to hold and r,+ve harm� <br />les5 Ihc City ol Eve�eli Irom any ond all cla�m; tor Aamn9es. costs <br />e.pensrs. or causes ol aclion Ihat may anse bewuse o� installatlon <br />anA mnintenancn ol Ihe ��+provemenl or ol�cr n{7hPol�way usr he�elo <br />�pplied lor anU lurther a9rces lo iemove same upon nol�ce'Iwm the <br />,Gdy nnd lo replace pul�hC pf�operly tl.lmageA �hPrpLy. / <br />Si�nal e ol APPLcanl. . <br />V/OR AU7HORIZED f3 TIIIS P[RMIT MUST BE S AR7[ WITNIN <br />I80 D VS CF DATE PERMIT IS ISSUED AND THEREAFTF.R IS TO <br />OE UIUG[NTLY PURSU[0 TO COMPL[TION THIS PFf7M1T AfAV BC <br />CANCELL[D BY f HE CITV UPON ANV STOPPAGE OF WORK (�N THIS <br />PROJECT O�CR 90 O��S OUFlATION <br />