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. r <br /> � <br /> � <br /> , <br /> � � <br /> i <br /> � <br /> ��� ,y, ' <br /> � y� � <br /> �� "� �2 � .. . . � r�ee�wo�kevo�mu. J� 3g� <br /> ��� Date 9. 7/9 _ eiea oew � 91/2' 19 - - <br /> y �"� Application For <br /> ��� i PU�LIC WORKS PERMIT p "°"""°'"„°° a <br /> To�aiFen <br /> � TO POSTING �� � L' 7Z ��s.noa�F�erma 5 <br /> ��g = , � - ,, - � aa�a���o�e 5 ��..- <br /> Q` � Print or Type Only � �` " �' �� <br /> >H� �, �, ; � ' ,`� <br /> , °' "` ° , <br /> ,o n <br /> C� (: �ii <br /> (.. <br /> (~Ay Nanabrook Tnr '���� �t i . 0 4 . �. ..9Q9f19 . SZ/ ��'�� Zi Phone + <br /> � M Owner � . [ � MaiNT�g Atldr's�.::i � � � ..: CitY P <br /> ��� � � ,� � �� , . . . .. . • � <br /> � — p f' r� C> r r c .,_ - t 1 ��' .--- � . <br /> � fJ Il ! U C � f 1 �r 1.�I <br /> n ..i i i i :f i � <br /> Hy � Mailing AAtlress City Zip Phone � � <br /> v�p qPPlicant <br /> _ i <br /> New SFP. Lot 62_lianabroolc Div i�l — ' <br /> Describe Proposed Work _ - — � <br /> t <br /> � — I <br /> _ � i <br /> Prolect Address(if known) 5�`�� 1::r piZ .SF � <br /> � <br /> Attach lour(4)copies of plans for pa�osed work� Draw to scale and note Ihe lollowing as applicable: � , <br /> • Properly Lines • Centedine ol street I <br /> • OuU�ne and dimensions ol all es�;ting and • Indicate North � <br /> • Show am pi.00seA grading changes <br /> proposr.d structure.s on the lo: � Show measurements � <br /> • Existing antl proposed ulilities <br /> f/ �a DO NOT WRITE BELOW THIS LINE <br /> I C�,I O <br /> ,� i PERMIT CONDITIONS � <br /> 1.All calls ter inspectlon shall be mad�24 hrs.in advance-phone 259•8810. <br /> 2.All work shell be pedormetl in accordance with ihis pormit and currrnt Ciry ol Everelt Design and Construcfion <br /> . ,_� � StenderdsandSpecifications. <br /> I <br /> `� 3.Call Locetion Undarground Service 48 hrs.before you dig.TOLL FREE NUMBER 1-800•424•5555. � <br /> 9 . install rock c�nstruction entrance behind driveway as per city O <br /> i etandard ri2�A and eroeion control. ag direcred bY Public Works <br /> ' '�� in�pector. <br /> I ��� 5. KP.P.p ci.Y.v st.reets clean at all times � <br /> 6. Curb gut.ter �nd eidewal.k i.n the p7.at. are new and undama�ed, <br /> any damage t.herPY.o sha] ]. be replaced at the discretion of the � <br /> !�'� puhlic Work� In:�pector. <br /> �� 7 . Any r_hange i.n the driveway cut must be approved by the Public O <br /> Works Tnepector. <br /> F1. Tightli.ne all. rooY'. Yard and drive:vay draina to storm d:•ain � <br /> �. stubs at back si�le of 37��'•�'7A�.�S. <br /> � �1 ' 9. Alj,lll9f Wclt.P.P hOXP.H tn Rt�a�f' �r enC� nf CO17BtL'UCt7.017. <br /> 10. Driveways shall Ue completel.y cured bef.ore drivine on them. <br /> !�_ ACKNOWLEUGt'IdENT OF CONDITIONS <br /> � �Y'J <br /> �_� �� The undersigned ownedapplicanl here6y agrees to aold antl save harm� <br /> �� Iess �he Cily o� Everelt Irom any and all claims lor dama9es, cosls, <br /> /'� eapenses, or causes ol aclion Iha: .iay arisc because ol inslallation <br /> P�4i� `�_, ,�_ ��—� p� and main�enance ol the improvement or othu riyhPol-way use herelo <br /> � � applied for �nd lur�her a rees �o rem ame upon nntice Irom thc <br /> Appro�d�or Cons uclion ���e City�nd b r lac///e�µµ��fff q o� ��etl Ihereby. • <br /> i �� � ,� � �/ y�� ' , <br /> / <br /> � �-. ., ,. /-�/7- <br /> �.'«i � ., ..� �.� <br /> FINAL INSPECTION ��`��11 � ���� <br /> Approved as Constructed i9naCure o 1 <br /> WORK AUTHORIZEO BY THIS PEfi j MUST BE S�iNRTED WITHIN <br /> PIIBLICWORKSDEPARTMENT I80 DA1'S OF DATE PEHMIT IS I UED AND THEREAFTER IS TO <br /> �Ar� 3200CetlarStreet BE DILIGENTLY PURSUED TO COAIPLETION.THIS PFRMIT MAY B6 <br /> ��rrEvoretC WA98201 CANCELLED BYTHE CITY UPON ANY STOPPAG[OF WORI<ON THIS <br /> Phone:259�d910 PROJECT OVER 90 DAYS OURATION. <br />