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��� <br />H <br />C H <br />>ti� <br />r <br />y H <br />fC ca <br />oH �1 <br />�LH� <br />VJ H <br />��� <br />OH <br />��8 <br />�Y (] <br />t"y� <br />ti y <br />g �' <br />C� l7 !�/� <br />�O� <br />1 ' <br />Date 6-�-9� <br />�� <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />I'��i'.i. WC.•In f�.inil t ._ _ __ _ <br />[ne.� u, o� • —9 0/29 8 0 9- <br />Puei¢ Wo�kf fee $ <br />iolnl Fec <br />�Pssnow Feeva�n S <br />o.,�.,���o�0 5 <br />Betty Owans 870G - 4th P1 EVPrett 96208 ;SS_4'+06 _ _ <br />Owner Maihng Adtlrese City Zip Phonc <br />Ma i 11 o A' � '� Pha e <br />}qppliCanl MailingAAtlress Clty �P <br />attached <br />Describe ProPosetl Work �.¢t nt r r'.,.,=$g��CO11VEit_ParF�f�n�a9 n lai�nAr}r�,��_ <br />Proiect Address lil known� a i - --- — <br />Attar,h lour (4) copies ol plans �or proposed work - Draw to scale and note the lollcwing as SnUlicaUlc <br />• Property Lines <br />• OuilinC an� di�ue�sions o� all CMisting and <br />proposed slruciures on ihe IOI <br />• Ezistin� antl proposed ut��ities <br />• Cenledine of streel <br />• Indicalc North <br />• Sho�e any proposed 9indmg �hanges <br />• Stow me�swemenls <br />PEPMIT CONDITIONS <br />i. All calls br inspection shall be made 24 hrs. in advance � Uhone 259•8810. <br />2. All work shall be pedormed in aceordance wi�h Ihis permit and wrrenl Cdy of Everelt Descn and Constmcticn <br />Stan.iaids and Specificalions. <br />3. Call Location Underground Service 48 hrs. belore you tlig. TOLL FREE NUM�ER 1•800•424•5555. <br />N � i�L� 41 c. �/or�FS •t�c�L'tti1 IT �c-�2.'� �-Y� <br />-��„�vy1�- <br />�- �o-yc <br />Approved lor Conslruction Date <br />FINAL WSPECTION <br />Approved as Constmcted <br />�,�i.�iql PUBLIC WJRKS DEPARTMENT <br />� 3200 Cedar Slreet <br />Evcretl. WA 9�201 <br />Phonc'..'.59�6610 <br />ACKNOWLEDG[A1ENT OF CON�ITIONS <br />z <br />0 <br />H <br />� <br />O <br />a <br />The undersigned owr.er/applic:.N hereby ag�ees to hold, nd snce hamr <br />less the Cily of Ei�ercli from any anA all claims �o� Aamages. wsls <br />expenses, or causes ol action ;hal may arise because of Inslallaf�on <br />and mamtenqnce ot Ihe improvement or other righ4o� way use hereto <br />applied br and lur;her agrees lo remove same upon notice iron tne <br />City and to replace publm property tlamaged Ihereby. <br />Signature ol ApPlicant Date <br />WORK �UTIIORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DAi[ PERMIT IS ISSUE� PND TH[REAFTEV7 IS TO <br />BE DILIGENTLV PUHSUED TO COMPLETION. THIS FCRIdIT AtAY �L <br />GANCFLLED BY THE GTY UPON ANY STOPPAGE OP VJORK ON 1b1IS <br />PRpJLCT OVER `10 DAVS �URATION. <br />