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� � ,. <br />Date�t?J� <br />App�icatinn For <br />PUBLIC WORKS PERMIT <br />Pri�t or Type Only <br />Maili <br />�� � <br />O / —.jJ�% <br />PuL4c WmMc PmCm�'tl''"e''l <br />Oldp Oept � .�.__�_ �� �- <br />Pul���r. Korke Fee $ <br />iolel Poo <br />��vanni�ca�a�eg �O on <br />�aian.o Oun S � <br />City Zi� Phone <br />���a��i�p�� � MaiIln�Addicss Gdy <br />Describe Proposed Work - <br />P� oject Address pi known) - — <br />Attnch lour �41 copies ol plens for proposed worf: � Draw to scale and nnte Ihe tollowing as applica6le�. <br />• Property Lines • Centeiline ol street <br />• Outline antl dimensions of all eaisting and • Indicale North <br />oroposed slrudures on the lot • Show any proposed grading chan�7es <br />• Eaisting and proposed ulilitias • Show measurements <br />PERMIT CONDITIONS <br />1. All calls br inspectioo shall be made 24 hrs. in advance � pnone 259-881 5. <br />2. All work shall be perbrmed in accordance with this perrnd and curr�nt City ol Everott Design and Construdion <br />Standards and Specifications. <br />3. Call Lo_ation Undei<uound Sr.rvicc 4f3 hrs bclorc you dig. TOIL FREE NUM9ER 1'800•424-5555. <br />, ��i7r,�� /!� 2/ r17 <br />Approved br Consiruaion` � �a�e <br />_�-���-- ///7F <br />FINAL INSPECTION Date <br />Approved as Const�uaed <br />rvemtl PUBLIC WORKS DEPARTMENT <br />� 3'e0�] Cetlar Strect <br />Eveiett. W� 98201 <br />Phonc 259�l1015 <br />AGKNOWLEDGFA4ENT OF CONDITIONS <br />,1•1I <br />u <br />� <br />� <br />0 <br />a <br />The undeis��7ned owner/appGcant hereby ac�rees to ho!d and save harm- <br />less Ihe Cdy ol Hverell irom any and all claims lor damages. cosls, <br />expenses, or causes ol antion lhat may anse because ot installation <br />and mainlenance of the improvement or olher righbof-waY use hereto <br />applied lor and furlher agrees to remove same upon notice trom the <br />City and �o rePlace public properly damaged thereby. <br />� ,' <br />� � -f-. ,,, <br />� ,' / �-� 6, -T , c>>c/1--- <br />�gnatwe of AFa - ant ` 1 Date <br />WORK AUTHOAIZ[D BY THIS PERMIT MUST BE STARTED WITHIN <br />1�0 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION THIS PERh11T MAY BE <br />CANCELLEG BY THE GTY UPON ANY STOPPG3[ OF\VORK ON THIS <br />PROJ[CT OVEH 30 D�YS OURATION. <br />