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y N <br /> Itl � � 9v - S���L- <br /> p m � PuUhc\Yorks Pe�m�� <br /> C H Date1LJ-�--��� T� pOStING.___/��-�= eano�n� •� <br /> � � _ . ApP��cation For _ — <br /> P E R M 17 Pu�l¢Wo�ks Foe 5 <br /> � y � pUBLIC WORKS '°""°" <br /> LessPOP� FecPa�� s nO� <br /> � oro o� <br /> Ba�anca Duc <br /> N M <br /> � � � Print or Type Only <br /> � � ° ��?l�� � h��- �2 <br /> (vlZ 1 Pun�rlv / I–�� �—�-- <br /> Ci1 Zip Phone <br /> � y �� � � ���r1 MadingAddress/ <br /> ty Z Owner <br /> I-� H <br /> d y M <br /> � O y �`�-. Ciry ZiP Phone <br /> qq ❑ � Mailing Adcress <br /> � tC � APPlicant — <br /> O y <br /> N <br /> Descrihe ProPosed Work <br /> � <br /> 7Z�'" CY'OWn D/'_ _ � <br /> Prolect Address(�� known) � <br /> Atlach lour 1�1� copies of Plans lor p�oFosed wo�k-D�aw to sca�e and noie�Ce��te line of streell��I`. N <br /> • Froperry Lines • Indicate Norlh <br /> • Outline and dimensions of all existinc�and � Show any pwposed�J�ading chao9es � <br /> proposed slructures on Ihe lo� • Show measuremenls <br /> • E*istin9 and proPosed utilities <br /> i' ` 00 NOT WRITE BELOW THIS LINE O <br /> ` '., <br /> �� PERMIT CONDITIONS � <br /> 1 ,� 1.All calls for inspection sh_ be made 24 hrs.in advance-Phone 259•8810. <br /> 2.All work shall be pedormed in accordance with this permit antl cunent City of Everell Design and Coneuuction <br /> '�r Standards and Specilications. � <br /> �� 3.Call Location Underground Service 48 hrs.belore you dig.TOLL FREE NUMBER 1•800•424•5555. <br /> O1/��/91 1�16FM OOOPH5:91 � <br /> , � <br /> D000?6014 <br /> CLDG 57'a4.00 � <br /> I �"� FIEG 4�b5.00 <br /> HECH 4140.Q0 �/� <br /> PLN CH �45.50 r� <br /> 1i�' E SRCH 44.SD � <br /> PWINSF' 420.00 � <br /> k00007C99 <br /> WRTER 5650.00 <br /> � ��'`' k0002805� <br /> SEWER 830.00 <br /> ��I ACKNOWLF' .��N� �,�,n`�j�,���ONS <br /> I /�7�1F_7 The undersi9ned owner/applicant here�y agrees to hold and save harm� <br /> ��� ��`� less Ihe C�ry ot Everelt Irom any and al'. claims lor dama�es. cosls. <br /> �•� expenses, or causes ol action Ihat may arise because ol installation <br /> and maintenance ol the imp�avement or olher righl�of-way use hereto <br /> '� � Q �e�/�/G� applir.d for •�ntl Iwther agrees to remove same upon notice Irom ihe <br /> � Date City end lo •Place Public property damaged lherehy. <br /> ApUrovnd lor Construc ion / <br /> ���G�� /�-/I-%/ ti,t . <br /> / Datc � � Dale <br /> FlN�L INSPECTION S� n� ure ol Applicant <br /> ApprovedasCansiructed �ry0 K AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> evcrMt PUBUC WORKS DEPARTMENT BE DIDLIGENOTLIDPURSUED TO'COMPLETION.DTHIS PERMIT MAY BE <br /> � 3200 Cetlar Stroot CANCELLE�BY l HE CITY UPON ANY STOPPAGE OF WOFK ON THIS <br /> Everol�.WA 98201 <br /> Phane:259�8810 PROJECT OV[R 90 DAYS DUR1�f1�1 <br />