|
���
<br />��r�i
<br />>H[/r
<br />y z r�-�
<br />� H�
<br />'TJ H'�
<br />V1 H
<br />� H �G
<br />O H
<br />H/1 C��7 �
<br />y� V �
<br />zH�aH
<br />r r+ H
<br />�N
<br />H
<br />o G �n
<br />���
<br />z y v�
<br />H O cn
<br />/ /
<br />D2te �' � �c�
<br />i�np:��:at��.n�� I-oi
<br />PUBLiC V'JC,RK� PERMIT
<br />Print or Type Only
<br />Applicant
<br />Describe Proposed Work
<br />_�<.� -�� � , �',��-
<br />a , �LL';.,�� r 1 � . }
<br />Idaihng A� dre-s - GU�_— -'iU
<br />�G��' (�(. � ��y� �r "^ �—�C
<br />Maiiin�l�ddress City ��P
<br />Z/G
<br />f�C'.:c 1:u�ks Pcrmil • � �,
<br />�--,��--i G. , _
<br />:ii�i i o���i . _,_ � -
<br />PUGhC UJorFi F¢U
<br />Total Fce S ----
<br />Lrn:. l.Cl�� Frn P.u�1 'S . �
<br />...., ... � ��1�
<br />�,�, l—
<br />Phone
<br />3i2/ -� z �'s s��. � i.�/, —.
<br />Pwject Address (il knownl - " --- -- —
<br />F.�tach four (�) copies ol plans �or propo=ed w0�k - Drav: tr �,r d�.� ;:nef n�te Ihe followin� 25 applic�eble�.
<br />• Property Lines • Centerline ot strect
<br />! Outline and dlmenslon, ol all esis�in5 and • IndicaF '!or!h
<br />proposed 5truciures on ihe lot • Sh,ow oi ; pr�:�Gozed 9radin9 chanac�
<br />• Existing antl proposr,A utilities • Show nieasurmn�nts
<br />PERMIT CONOITIONS
<br />'� �. t. All calls lor inspeclion shall be made 24 hre. �n advence - nno��c� 259-881 5.
<br />.e � 2 NI work shall be perfo�med in acCordance .vllh Ihls pernut and c.wien; Qly ol E:��rntl Uesign antl Gon;�ructi„�
<br />Standards and Specifications.
<br />3. Call Location Undergrcund Serv.ce 40 hrs. be�fore you din TOLL FR[E NUMBER 1-SUO•424•5555.
<br />/ A iv��,� ' ;-; ._� i�� r� f, , � ,
<br />'7r . �%f�i.r/'rf'��c .i FS: -' . .
<br />%�'O� 'Z�i"'! r" � Lf fi<'!/�Ci."'i
<br />/ :
<br />�, J�;�,-,9c c
<br />�n�,�����--y
<br />���,�,, ��:; - ;�i
<br />/2 �� C"v�✓c;t� ;>�- � . , , ,,. � �; � . . , _
<br /><:.'�.... . .. c ., i�,< .:�, . .. �." �'. ��:.'.-.1,,:-< .. .
<br />,. ,, �.: . ,� , ,�: i��.- : , ,_,,,,�
<br />�._ -, .
<br />��.. 7;�
<br />` r � � � 'C"l: �^`�
<br />�pproven lor Gonsliueiio / Datc
<br />/ � �. /y -�'�
<br />�( y�U � — ---
<br />FW�L INSP[CTION �`���
<br />Approved as Gonstrucled
<br />everr�� PUBLIC WORKS DEPAR'fMENT
<br />� 3200 Cedar Strcet
<br />Eveielt. WA �J8201
<br />Phc: u�: 259-AB 15
<br />�
<br />O
<br />ACKNOLVLEDG[MGNT OF CON�ITIONS
<br />The uncwrsi9nr,d o�vner/applicant hereby agrees to hold and save harm-
<br />less �he City o� Everelt irom any ano all claims for dania�jes, ces�s,
<br />e;:penses. or cau5es d action that may arise bec�use ol instaliation
<br />and maiNonance of IY . improvement or other �ighl-ol-way use nereto
<br />apphed lor and lurlhm a� •�s �o remuve same upon nolice from the
<br />City and to rePlaco P��bli.: �,�,n,;ei�1' duniaped iherebY.
<br />J \ ���`, , /\ �_., = I7 ,.'L�— � !u G�
<br />i �- _ti"t�a..ti �_�.at.w
<br />Si�noWrr, of i�pplican� Date
<br />WOFiK AU111a�RIZEU dY TIiIS PERMIT MUST BE STARTED WITHIN
<br />1BG DFYS OF DATE PERMIT IS I:iSUED AND THEREAFTEF IS TO
<br />BE CILIG[NTLV PURSUED TG COMPLETION. THIS PERMIT MAY BE
<br />C�Id�ELL[D BY ll-IC CIT'I UPON ANY STOPPAGE OF W09K ON THIS
<br />PROJEGT pVER 90 0�1Y5 DUNAiION.
<br />
|