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Dala ��� '( _ � <br />AppLca�ion For <br />PUBLi� �JVORKS PERlVIIT <br />Print or Type Only <br />Applican! <br />���a ��- y3�. ;U� � <br />Mailing Address City <br />Mailing Address ���Y <br />Describe Proposed Worh � L�J `� ~ /� <br />�5's`iZ � : <br />Pubiic WaAs P� �q— <br />BmB. Deot • .�J i J U�% <br />vuoi�c wo.ks Fee S <br />Tolal Fee <br />Lesa Rpn� Fee PniC $ /� <br />Balance Due � _ c����— <br />� �0/_S <br />.�.2 3 C�_s; - �b`�:� <br />Phone <br />Prolect Address (it known) �n� �� � -- ��l�U�� y�y Avl J', E- <br />AUach lour (4) copies o' plans lor proposed work - Draw to scale and note the following as applicable: <br />• Property Lines • Centerline ot street <br />• Oulline and dimensions ol all existing an:l • Indicate North <br />prop sed strucW res on Ihe lot • Show any proposed grading changes <br />• Existing and proposed utilitics • Show measurements <br />L <br />PERMIT CONDITIONS <br />i. All calls for inspection shall be made 24 hrs. in advance - phone 259•SF31 5. <br />2. All work shall be perlormed in accordance with Ihis permit and current City of Evere�� Design and Construr.tion <br />StandarAs and Speciticalicns. <br />3. Call Location Underground Service np hrs. belore you d�n. TOLL FReE NUMBER 1-800•424-5555. <br />Appm4ed lor Consl tion <br />�� ��'� �'�. <br />FINALINS�PCiION '' �1 <br />Approved as Constructed , �'� <br />c�erMt PUBLIC WURKS DE <br />� 3200 Cedar Sireet <br />Everel�, WA 98201 <br />F�honc:259�8815 <br />� <br />Q <br />ACKNOIYLEDGEMENT OF CONDITIONS <br />T� �ersigned owner/applicant hereby agrees to hold and save harm� <br />I, .� City ol Everetl �rom any and all claims lor damages, costs, <br />� .es, or causes of aclion that may arise because of installa�ion <br />., ��aintenance of the improvemcnt or other right-obway use hereto <br />ad tor and further agrees lo remove same uoon notice from the <br />Clty and lo replace p�blic property damaged thereby. <br />��,` � "� 3 `� <br />Signature ol ApPlicant Date <br />WORK AUTHORIZED BY � I° PEfiM1T MUST BE STARTED WITIiIN <br />1d0 DAVS OF DATE PERMIi IS ISSUEC AND THE7EAFT[R IS TO <br />�E OILIGENTLY PURSUED TO COM11PLErION. THIS PERMIT MAY BE <br />CANCELL[D BY THE CITY UPON AN1' STOFFAGE OF WORK ON THIJ <br />PROJECT OVER 50 DAYS DURATION. <br />z <br />0 <br />-i <br />c� <br />m <br />-� � <br />..� <br />�n x <br />m <br />0 <br />�o <br />mc <br />n <br />--I c <br />O 3 <br />ri <br />—1 z <br />m ~ <br />o � <br />y -a <br />rx <br />� � <br />< <br />�� <br />O = <br />3 <br />�m <br />x <br />m �— <br />� <br />0 <br />C7 R <br />C N <br />m �^ <br />z :-, <br />--� r <br />m <br />n <br />� <br />_� <br />x <br />i <br />� <br />c <br />[- <br />r. <br />