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y� / <br />Dates� UL_�= 1 o„m��wa..,�.,m�,y. }�7f�.7�%- 1�_' <br />AnP� ^.alion For e�M o�m •—IJa OL���.�_ _. <br />PUBLIC V✓O��KS PERM:'T °�°�K�°°�.•�.° <br />,o�.� ��. s __— <br />«,,.�o� �,. o.,� s <br />oau�«o�n S ��� <br />Print or Type Only TO POSTING ������ <br />`tYll U1�Pl'1C��' I �.1��f" � o��-������ 1� YA f-I (�"7/dlYl ��.b� ��C..J <br />�� Owner MadinqAdtlress C�ly Zip POone <br />r l�iJ/!" . <br />Apphcanl Maillny Atltlrcss Ciry Lp Phone <br />Desc�ibe Pwposed Wark <br />Pmiect Address �il knownl <br />Fl�ach lour 141 co0ies 01 Plans lor pm0o5e0 work � Dr.+w to scale, n� no�e ihe lallowing as appLwble: <br />Y Property Lines • Centetlme oi sireet <br />• Oulline and dimensions ol oll exisbng antl • Intlicate Notlh <br />P�oOosetl slrucWres on ihe lo� • S�ow any propo5etl gratli�9 chcnges <br />• E.�shrq an� proposetl utilitles • Snow mcasuremeNs <br />PERMIT CONDITIONS <br />1. All calls Ir, inspeclion s�all ba made 24 hrs. in ativance- phone 259•8810. <br />2. All work shall be peAormed in acroraance wi�h this permil antl current City ol Everell Design antl Constmction <br />StantlarGs and Specificalions. <br />3. Call Lontion Undergmund Serv¢e 48 hrs. �elore you tlig TOLL FHEE NUMBEH 1•800•4i:4•5555. <br />� / 0 <br />•.�/ f�er� ?:� 3 �c g <br />Appmvetl lor Cons mctio Datc <br />����—, <br />��� <br />RNFL INSPECTION Dale <br />Apprwetl as Construcletl <br />everell PUBUCWORHS�EPARTMENT <br />� 3200CetlarStree� <br />EvcreLL V/A 98201 <br />P�one. 259�U��0 <br />AGKNOWLEDGEMENT OF CON�ITIONS <br />� <br />O <br />�w <br />�/ <br />O <br />a <br />Tpe undmsi9ned owner/appLcant hereby a9rees lo holtl an� save harm� <br />less tne City ol Everelt trom any anE all claims br damaecs, cosls. <br />crry:nses. or wuses of action that mny arlse because oi installahon <br />anA inainlenanco ol Ihe improvemetd or other nyhl-oi�way use hereto <br />applie� lor antl luriher a9rees to rCmove same upon notice Imm ��e <br />Cdy antl lo replace puUhc OwOerly tlamaqetl Ihereby. <br />�---� R��QE,,,t ti - s -� � <br />Si9natwe ol Appbcant Daie <br />WORK AUTHOHIZED BY THIS PERMIT IdU6T BE STARTED WITHIN <br />1B0 OAVS OF DATC FEFMIT IS ISSUED AND THEREAFTER IS TO <br />BE �ILIGENTLY PI!Rt �VED TO COMPLETION. THIS PER!dlT MAY 9E <br />CANCELLED BY Tlft CITV UPON ANY STOPPA6[ OF WOPK ON iH15 <br />PROJECT OVEH 90 DAVS DURATION. <br />