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Date �}Ji_;;) � i <br />Application Por <br />aUBLIC WQRKS PERMIT <br />Print or Type Only <br />Mailing Address <br />Describe Proposed Work <br />Projecl Address (il known) <br />City <br />r�oi.-vm��� a�,m�� :: <br />omy.oco�., ' .�� <br />Public Works Fee S <br />Tolal Fee <br />Les.A4��. Fee Paitl 5 <br />�alanceUuo $ <br />-,_ �df _, <br />c�� <br />Attach four (4) copies of plans for proposed work - Draw to scale and note the following as applicable: <br />• Property Lines .• Centedine of streel <br />• Outline and dimensions ot all existing and • Indicate North <br />proposed struct�res onthelot • Show any proposedc�rading chan9es <br />• Existing and proposed utililies • Show measuremeNs <br />PERMITCONDITIONS <br />Phone <br />ne <br />1. All calls tor inspec[ion shall be made 24 hrs. in advance - phone 259-$81 5. <br />2. All work shall be performed in accordance with this permi: and curreM City of EvereL Design and Construction <br />Standards and Specitications. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800-424•5555. <br />i �/�� ,,r/ �Y�r p � <br />�(L{/`-tl'C�CUG��---�>-?�rc,t-l� !"'�/�.P¢i.G'GL:'_e�� <br />b <br />Approved for Construction <br />FIIJAL INSPECTION <br />Approved as Constr�cted <br />evere�t PUBLIC WORKS DEPARTMENT <br />� 3200 Cedar Street <br />Evereit, WA 98201 <br />Phone: 259-A815 <br />��j' ii <br />�/J�i <br />� � <br />i-/�-�� <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undersigned owner/applicant hereby agrees to hold and s�ve harm- <br />-- � Iesa Ihe City of 'cverett from any and all claims for damages, costs, <br />expenses, or causes of aclion that may arise because of in�tallation <br />and maintenance of tl�e improvement or other right�of-way usa: nereto <br />applied for and further agrees to remove same upon notice from Ihe <br />Date City and to replace pu6lic property damaged thereby. <br />Date <br />Si9nature of Applicant Date <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIP.I <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />