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- ---- -- - --- -_ _ --- _ _— - _--------- - --- <br /> . , .. �� � 5��c, � - � , ,-�ay"... <br /> Date.�1L �`"� �V J- 2�—S � Pub6c Wo�M Pnrmil• ��' � <br /> 1 <br /> qpplication For eiag oeo��• '� <br /> PUBLIG WORKS PERMIT ruoecwm��veo $ <br /> iola�Gee <br /> � �y { Less Ao01 fee Pa�O 5� . <br /> } Bmanc.Due S ��� <br /> � � H Print or Type Onty — , <br /> �� � <br /> K o 1�1t 1 ��,`�,v�i�,:�r.�r �� ;�� ,`�- !55''� L �,,�,rrUcu! 7�1s- h'x97 <br /> � H� Owner � Malling Atldress� City 2ip hona . <br /> Hy~ �� �L �C'VIV ��" �v�i ILR ��� _�y � �fJ Cal�(A / - `1� af�� �`, �'�/��� , <br /> � Yp+� �p�i�y�� Mailing AdAress GIy ZiP Phonc �, <br /> H t7 � I� ,) � <br /> M �g ' Descri5e Propo4ed Work �{(�/ .��1 t-C• '�l�l��1,J �f� �Sr � �-�� '�1Gf Fd .r'i�/{]l,.II} �. <br /> ( � <br /> Hy � <br /> zyy � <br /> t" yy . — , , ! . <br /> gd� 190Z NIC-�vr N J��/c � ', <br /> � � Prolect AAdress IA known) <br /> [s7 Aitach�our(4)COpieS ol plans for proposed v�ork-�raw to scalr antl note the following as applicable. � i <br /> �'a' � • Propeity Lines • Centerlinc:ol street /A , <br /> • Outhne antl tlimensions ot all existing antl • Indicate Norih V� <br /> � proposed slructures on ihe Iot • Show any proposeti gratling chanoes � <br /> • Exieting and proposed utillties • Show measurements � I <br /> , DO NOT WRITE BELOW THIS L WE O �' <br /> 1 � <br /> � � PERMITCONDITIONS <br /> � 1.AO calls lor inspeclion shall be made 24 hrs.in advance-phone 259•881 Q � '�, <br /> 2.All work shall be pedormed in acwroance with this nermit and current Ciry of Everelt Design and Con�;truclion <br /> Standards and"�pecilications. � <br /> �, 3.Call Location Underground Service 4B hrs.belore you dig.TQLL FREE NUMBER 1•800•424•5555. � ; <br /> I _� ' � . . . .a• - - . '" '� � � <br /> . � ,. _ ..�.—.�._ ..i � <br /> �. � -.--7LSLr'++�+t�aa, i <br /> � I <br /> . �� �I 1� :; � r �: � ��, .r � � � ��� ni' r '� !�i.] "'Jt. . <br /> �. 7 .a�1`,Tl�1�L i� �t�!S'II. :"i�Yt�. ' f'J 1J I1 ' 1 . . . � 'I <br /> 2 � Plr r.�-� l.:�n ,� ' . �I1 i�I .n �.I.l.. '.ltll' T•. �,;,,:p: �� �.�. ..;(1 � . . ''' I ���� � <br /> + � ��',�.'! ' I '1 P:117' O I� <br /> __ a <br /> �-- � <br /> ACKNOWLflDGEM[NT OF CONDITIONS <br /> � The undersigned owner/apPhwnt hereby agre�s Io hold and save harm� . <br /> less the Gty ot Everelt Irom any antl all claims for damages. costs. � <br /> , � ��� ezpenses. or causes ol action Ihat m2y arise because ol installation �� <br /> �—4 11 1 L �` i L G and main�enance of the improvement or other right�M-way use herelo �. <br /> Y � �� - applied lor and furlher agrees b remove same upcn notice hom Ihe <br /> Approved for Co�struction �a�e City and to replace public Droperty damaged ihereby. �, <br /> ' ' `, <br /> FINALINSPECTION Dafe __t�C.��-�'. <br /> Approved a6 Cons�ructed Signature ol Applicnnl Date <br /> VJORK AUTHORIZED EY THIS PERMIT MUST BE STARi[D WITHIN <br /> . evcretl PUBLICWORKSDEPARTMENT 180 DAYS OF DATE PERId1T IS �SSUED AND THEREAFTER IS TG . <br /> � 3200 Gedar Sireet 8E DILIGENTLV PURSUcD TO COMPLETION. THIS P[Fi1dIT .'v1AV B[ <br /> Everell.WA 98201 CANCELLED BY T4E LI'.Y UPON ANV STOPPAGE OF WOPK ON THIS <br /> Phone:259-8810 PROJECT OVLi�99 DA'f5 DURATION. <br />