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P�mec Wn��e Pmmn� ��_ �'� <br /> Date,�%f� /-7�//n� <br /> Blep Deo� ��`J� <br /> Applicatlon For _ <br /> PUBLIC WORKS PERMIT ��ei�cWorw�fee <br /> Tot�i�es � <br /> �eu�oo� �aevua 6 <br /> Bui�nce Ova � �O� <br /> Print or Type Only <br /> �1�'JT'A �-e�A�l, � �'d, �� �$'` �a�� �o y'/ yS/- //so <br /> Owner Melling Address Cily Zip Phone <br /> �i�'/�v'i - _ <br /> ppplicent Meiling Atldress C1ty Zip Phone <br /> Deacrlbe Propoaed Work � ' �Q' � �����' ' � <br /> _— � <br /> � <br /> Project Address(lf known) �'3O /� ��u C�n� �� -- � <br /> � <br /> Attach lour(4)cop�es ol plens lor propoaed work-Dmw to scele end note the following as eppliceble: � <br /> • ProDerry Linea • Centerline ol slreet <br /> •Out�ine and dimensions of ell ezisting and • Indicete Norih <br /> proposed atiucturea on the lot • Shnw any�roposetl grading changes <br /> • Exisling and proposad utilities • Show measurements M <br /> W <br /> DO NOT WRITF BELOW THIS LINE � <br /> PERMIT CONDITIONS <br /> 1. AI�cells lor inspection shall he made 24 hrs.in advence�phane 259•881 5. � <br /> 2. All work shell be parformad In eccordence with thie permi�anA current City ol Everel� Design end Construclion <br /> Stenderda and SpacJicalions. � <br /> 3. Cell Locntion Underground Service 48 hrs.belore you diB.TOLL FREE NUMBER 1•800•424•5555. <br /> � !'GwSf,oUc� 1j,fywEa[S f'o,e .�oD�rc� Daeu.uS.�O[i.—J O <br /> S. do NoT 9c�t.c ��'�vNa lvn�TOv,es' � <br /> � <br /> O <br /> a <br /> qCKNOWLEDGEMENT OF CONDITIONS <br /> The undersignec owneqepplicenl hereby egiees to hold nnd snvr hann� <br /> -- less Ihe Gty ol Everelt Irom eny and all cleims tor oemay�s. �:��s�s. <br /> / expenses, or causop ol ection Ihat mny arise beoruse ol Ir,stallation <br /> LC✓��.�/�7 �r �7` / end mainlenan�e ol the imProvemenl o� olhar righ��ol�weY use hereto <br /> �1i/ j7po_6Y '���7�6'G apphed for und farther ngre to remove some upon notice Irom 1ho <br /> ��' <br /> Approved lo . msiruction �a�e City rep�uce public p ty,da eA there�'�y <br /> / <br /> :��" '�P�t��� /.7 -!`�-F6 _ . � <br /> F�INSPECTION �'��P Dnle <br /> qpp�aved as Consirucled SignaWre o'App can <br /> WORK AUTHORI�ED BV THIS PERMIT MUST BE STARTED WITHIN <br /> everel[ PUBLIC WORKS f1EPARTMENT 1B0 DAVS OF DATF. PERMIT IS ISSUED AND THEREAFTEFl IS 10 <br /> � 3200 Cedar Streel BE DILIGENTLY PUASUED TO COMPItTION. THIS PERMIT MAY BE <br /> Everelt.WA 98201 CANCELLED BY THE GTV UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone�. 259�8815 pROJECT OVER 90 DAYS DURATION. <br />