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��x <br />�H� <br />H�� <br />fC O <br />'il � � <br />� <br />�:p <br />HC <br />ON <br />��g <br />a� �� <br />C" y Z <br />gyy <br />o�� <br />��� <br />��/ ., , ... <br />Date r�ni�� wo��. re�mn . <br />omaoen�.• 4T ��'�'�, <br />qpplicalion For <br />PUBLIC WORKS PERMIT PublolnlFe�Fee s <br />TOPOSTING_------- �caa�DO<<eePnlA: <br />Balanca0uo S <br />Prinl or Type Only <br />�a-is� <br />�.r o� �ii.l.l�l gb� C'����_�l���C� �l�P�IL� i,�� QgaC13 <br />Owner Mailing Addr Cily 2ip Phone <br />0���`"�� Phone <br />Applicant Mailing Address ���Y Z�P <br />Describe Proposed Work <br />Project Address (if knc�vnl <br />Atlach four (d) copies ol plans �or proposed work - Drav <br />• Property Lines <br />• Outline nnd dimensions ol all existing anA <br />pwposed struclures on Ihe lot <br />• Existing and pioPosed ulilities <br />lo scale and noto Ihe lollowing as applitoble: <br />- • Centedino ol slreet <br />• Indicele North <br />• Show any propo5ed greding tl�anges <br />• Show measuremenls <br />'�' PERMIT CONDITIONS <br />1. All calls for Inspection shall be mede 24 hrs. in advance - phone 259•8810. <br />''2. All work shell be pedormed in eccordance wilh ihis Dermil end currenl City of Everelt Design and Construction <br />� Standards and Specifications. <br />3. Call Locatian Underground Service 48 hrs. belore you dig. TOL:. FREE NUMBER 1-800•424•5555. <br />' <br />I <br />�' <br />� <br />�cf.�� CL�z,��%�/'�'uf �ca�,f _�iLve� <br />U <br />Approved lor Construclion Date <br />FINAL INSPECTION G:+�e <br />Approved as Conslructed <br />PUBLIC WORKS DEPAiiTMENT <br />3200 CeAar Slreet <br />FvcrMt, WA 98201 <br />Phone' 259�8810 <br />������ <br />y z� -�� <br />ACKNOWLEDGEMENT OF CONDITIONS <br />Tho undeisigned owner/apPliwnl hereby agiees lo hold and save harm� <br />less Ihe Cily ol Eveiell Imm any and all claims lor damages, cosls. <br />erpenses, or causes ol aclion thal may arise because ol Installalion <br />and mainlennnce cl lho fmprovemenl or olher right�ol�way use herelo <br />apP��ed lor and lurlher agrees to remove same upon nolice Ire.n Ihe <br />City and lo replace public properly damaged thereby. <br />Sic�naturc ol ApPlicant Da1e <br />WOFiK AUT110RI2ED BY THIS PEfiM1T MUST BE STAR7ED WITHIN <br />180 DAVS OF DATE PERMITISISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PI:RSUED TO COAIPLETION THIS PERMIT MAY 8[ <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON TNIS <br />PROJECT OVER 90 DAYS UURATION. <br />