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� � � <br />Q � <br />�o��o <br />�tl � �tl <br />N <br />�p <br />HC <br />�� <br />Qr <br />C'� y <br />M <br />W <br />M <br />�� <br />O � <br />� <br />Date� <br />TO POSTI NG_.? � ? <br />Application For <br />PUBLIC iNORKS PERMIT <br />Print or Type Only <br />Owner <br />New SFF <br />Describe ProPosed Work <br />�p/3 59 <br />cuE�m Wo�wa Pa�m�t • - <br />z- 90/24890 _ <br />B�ap �epl • -- <br />Pu��m wo�wa �ee s <br />TOIrI GCB <br />ciry, ��„ <br />lese Aon� Fee Vam S <br />eaia�co oue <br />s Z'�_ <br />Project Address lil knownl tiuv i o..o.•.. — <br />AUach four (4) copies ol p�ans tor pwposed work � Draw to scale nnd note Ihe tollowing as apDhca�le: <br />• Property Lines <br />• Outline antl dimensions of all existing antl <br />proposed structures on t�e lot <br />• Ezisting antl D«Pased utilities <br />• Centedme ol slreet <br />Q Indicate Norih <br />• Show any proposetl 9rading cha�9e5 <br />• Show measurements <br />� {�� PERMITCONDITIONS <br />` 1. All cell6 for inspect�o� shall be made 24 hrs. in advance - phone 259-8810. <br />i 2. A�I work shall be peAormed in accordance with this permit and current Ciry ot Everatt Design and Consiruction <br />Standards and Specilications. <br />� 3. Call Location Underground Service 48 hrs. belore you diQ. TOLL FREE NUMBER 1•800'424•555 . <br />� �� <br />4.ANY CHANGE IN THfi DRIVfiWAY CUT MUST SE <br />gy Ti+S PUBLIC WORKS INSPECT�k. <br />5.TIGHT LINS D�WNSP��TS TO SIDR SHWER._ <br />B.KESP I:ITY STRSSTS CLHAN AT ALL TINES. <br />7 TOYTHB SATISFACT$ON OF TH& PUBLI,CIWORK <br />`1>�.Q.a.�J�- n'�c�� �_Z�'�b <br />Approved for Constru�oF <br />Date <br />�-��-��� - <br />o� �e <br />FINAI INSPECTION <br />qpproven :ns Con�trut�ed <br />cverett PUBLIC WORKS DE?APTMENT <br />� 3200 Gedar Street <br />Everetl WA 98201 <br />P�one:259�88�0 <br />347-8484 <br />W <br />� <br />� <br />� <br />� <br />09/18/90 12:04PM OOORM3T05 � <br />APPROVHD / � <br />N0002`.u"`17 � <br />B SRCH s4.50 <br />N00027804 � <br />LL BE REPAIRBD �R f2.5U <br />S DHPT. N00024890 O <br />g�p(g f486.50 <br />�� �,5.� a <br />��, ,�.� <br />PtN CH f23.40 <br />B SRI�I i4.50 <br />pR�y t20.00 <br />ACKNOWLEDAnEcI�rv�T Ofa ��aDlarIONS <br />The undersigned owner/aDPli <br />�1w•nereby e9�� hold and save harm� <br />less the City ot EvereU Irom any and all claims lor damages, costs. <br />expenses, or causes ol action that may a��se because oi installation <br />and maintenance ol the improveme�� or other righPo��way use hereto <br />applied �or antl lurlher a9�ees to remove same upon notice Irom the <br />Cily and lo replace pubhc p�operty damaged thereby. , <br />�Oric� �� f /d 9L <br />a�e <br />SignaWre of AppliWnt <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSU�D AND THEREAFTER IS 10 <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY 8[ <br />CANCEILED BY THE CIT`! UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVEF 90 DAYS UUNATION. <br />