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0 <br />��� <br />! H fn <br />��� <br />H R! <br />�VJH <br />� n d <br />ON <br />��g <br />QY (] <br />t'y� <br />Ny <br />gd� <br />�� y <br />H <br />Dale Z� R� <br />� <br />Applicatian For <br />PUBLIC WOF�KS PERMIT <br />Print or Type Only <br />�k <br />Describe Pro�oseA Work <br />prolec� Address (�� known) <br />Public Woib ParmA • / / <br />Bleg. �aol.+ ���{9 � / <br />P�AIICWorkeFeo $ <br />iolnl Fae <br />Loss An01. Fae PeiJ $ <br />Oaionco Duo <br />Cily 7_ip Phone <br />Altach lour (4) coA�es ol plans lor pmposed vrork - Draw lo scale and nole the lollowing as applicable: <br />• Praperty Lines • Centedine ol slreet <br />• Indicate North <br />• Outline and dimensions ol all ezisling and � S��ow any proposed gradin9 changes <br />pwposed struclures on the lol � Show measuremenls <br />• Ex�sting and proposed utililies <br />PERMIT CONDITIONS <br />1. All calis for inspeclion shall be made 24 hrs. in advance • phone 259•8810. <br />2. All work shall be pedormed in accordance wilh ihis permil and currenl Cily of EverMt Design and Construclion <br />Standards and Specilications. <br />3. Call Localion Undergr�und Service 4B lirs. belore you di�. TOLL FREE NUMBER 1-800-424•5555. <br />,���� ���� ��,»��- � ��-��.�n <br />, , <br />���,�� <br />3- �z-yi <br />Approved lor Construction ���0 <br />fINAL INSPEGiION Dalo <br />Approvod as Conslrucled <br />evcrc�t PUBLIC WORKS DEPARTMENT <br />� 3200 Cedar Slreet <br />Everoll, WA 98201 <br />Phono: 26�3�0810 <br />ACIQJOWLEUGLMLNT OF CONDITIONS <br />W <br />H <br />�w <br />_ / <br />Z <br />O <br />H <br />� <br />� <br />a <br />The unJoisi��ned oWimdaPP�lcant hareby afl�e�s lo hold and save hnrm• <br />Iess Ihe Ciry ol Evcrell Irom any and all clalms lor domages, cosis, <br />ezpensec, or causes of action lhal may adso bacause ol Ins�ellolion <br />and mniNcimnce ol Ihc hnprovomont or o�hor ri�hl•obway use hereto <br />❑ppl�i�d lui nnd Iwlhnr a�peas lo iamovo smnn upon nolice Irom Iha <br />Cily and to ieplace pub�ic property dama9ed theroby. <br />Sipnaluro �I A�plicant Dato <br />WORK AUTI�IORIZC-D E3Y TIiIS PERMIT MUST DE STARTED WITHIN <br />1U0 DAYS OF DATE PERMIT IS ISSUE� AND TH[REAFTER IS �TO <br />BE DILIGGNTLY PURSUED TO COMPLETION. THIS PERIdIT MAY BE <br />CANCELLED BY TIi[ CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />--� <br />