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:�:Z/ �l� . ,.. . "-o�'Z_9g _. <br /> Data_ �- � I% . . _ )�� �`- <br /> . / ��.::� orni .—����(/— <br /> nppl�cation for <br /> PUBLIC WORKS F'ERMIT `°°;o,`;F���°� 5 -- <br /> Lesc<oa�Fce Pa�o 5 <br /> H O H o.,i.,��o o�c 5 Z�-- <br /> ��� Print or Type Only — <br /> >ti <br /> A�7s <br /> � P �� /y �i/C�iA� ���'' �.�"'� <br /> H �� P -(� �- � -ri%�<7 �r ar k ,:� <br /> y z H Owner Mailin9 Atltlress City ZiP Phone <br /> .G n <br /> H�1 ��t <br /> '�9 H'�+J - <br /> y H Applicant Mailing Address Ctly Zip Phone <br /> � O[=1 � //,, <br /> O H C Descri6e ProPased Work _(�.(�,���! ��-I� '����� ��"' �) <br /> '.Ll ��i — <br /> t� <br /> G]� O <br /> a y�i W <br /> r H y —� pZ-- 1=s- O2 SC- L <br /> � y Proiccl Atldress lil knowN - -� r� <br /> F-1 <br /> � C� Attnch iow (a�cop�es o�plans�or pwPosed work-D��.:. t�. �. :d.-anr: �-,nb�tho foiiowing as opphcablo: � <br /> � [�i t+ • Pr:perty LineS • Crnierline ot siree� � <br /> C�i • OutGnn�nd tlime�sion5 oi au��.:��nnq ir' • In�bra�e Norih <br /> yQ� nronosed svuc�ures on tne iet • Snow any piopOsed gLlAinq chango�, <br /> • ExSimq antl proPOsed uiilibt'; O 51'�ow measuremen!s /�A <br /> W <br /> DU NOi "JIiITE HELOiN THIE LINE O <br /> PEPMIT CONDITIONS <br /> 1.All calls�or inspe[tion 5hall b�madc 24 hrs.in ativ.��cs-phonc PS�'88�O ^ <br /> 2.All work shall be pedormetl m accordance with�his permil o��d cmrent Cdy o: E�.��n�u D�:syn antl ConsVur!ion ♦ <br /> Siandaros and Snecihcalions. <br /> � `� 3.Call Locatwn Underground Service 48 Ns.belo�e you aig TOLL FREE NUMDER 1-800•424•5555. <br /> !�r� z <br /> ��" �+ 9.ANY CHANGE IN THE DRIVEWAY CUT MUST BE APPROVFiD O <br /> �-• � BY THE PUP.LIC WORKS INSPECTOR. <br /> 5.CONNEC'C Ia�WNSPOUTS TO PUBLIC DFAINAGF. SYSTI�:M. � <br /> 6.KEF.P C7TY STREETS CLGAN AT AI.L TIMES. � <br /> (P '� 7.ANY DAMAGE 'I'0 THF. CURF3 AND SIDB'WALK WILL HI's 1:1?PAlit}tl) <br /> � " Tu 'CHF. SA'1'ItiI�ACTION OR 'PHI? PI�Ri,IC WORKS I�R}��7'. � <br /> � �� .� a <br /> �• �ti�� <br /> � � <br /> AGFNOPJLLDGE-h1[NT 01-CON�ITIONS <br /> �(:\,�`,.- The undersi9netl ownnr,'aPU��canl nereUY�9roe5�o hold anJ s,iec hmnr <br /> �..� , IC55 the City c! Everelt Irom any and all clalms br dmnnges. cm:ls. <br /> � � expenses. or causes ol atlwn lhat may arise bewuse el installabon <br /> -�'�i�A_�v\`Kw_v.. C�"Z9-�O `����� miintenanCe ol �he unprovement or oth�r n9hPn4way us�� In.veio <br /> applicd lor and turlhm a9ree5 to remove some uPon nobr.r ho�n Ihe <br /> Approved lor Conslr tion / Date Ci�y and(o replace puUlic proar,��y���mayed iheieby. <br /> `.-�.`�.�- r-,� - �, , / � � <br /> FINAL WSPGCTION �:ite ' � I��� , �. ':� _— _ <br /> Approvetl as Consiruelad i9n, w o�Appltcan� Date <br /> WOR AUTHORIZED BY, '�� PERRtIT MUST BE STARTED WITHIN <br /> r��ic�n PUBLIGWOHKSUEPARTMENT 180 D�YS OF DAT[ PE � IS ISSUEO AND THEREAFTER IS TO <br /> � J200Cednr5lreet pE DIIJGLNiLY PURSLf-�. �O CUM1IPLE71vN. THIS PEFI.IIT M11M' E36 <br /> Evntclt WA 90201 CANCR�_EU BY iHL CI1Y U!'ON ANY S1.�PPAGE��F 11'ORI!ON THI$ <br /> PhonC-25&Utl10 pHOJLCi OVLH PO �b11'.S I)IiF�ll[lN. <br />