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Date�� P„�„��w�,..��a,m„ <br /> Pinu Drn' • .� _.... <br /> Apphcation For <br /> PUBLIC WORKS PERMIT "°°�o,:.<:`°P s <br /> Lme�pplPoePe�Js -- <br /> 9ebnre Oue 5 <br /> Print or Type Only <br /> �I�m,��.�1� i��� ��1�� 5'�f'.� 9��.1���'�,-�so <br /> Owner T Maihng Address Git/ Zip Phone <br /> .��C'�-i��-��a.��l`1C�3 �--�'� 5�1 IIP�--�� <br /> Applicenl Mail g Address Cily Lp Phone <br /> Describe Proposad Work _ ` "� ✓� �/' `"""-����"'� <br /> W <br /> � � �Prolecl Addresa(i�known) <br /> Attach lour(4)copies of plena loi Proposed work- Draw to scele end note tho fallowing as eppliceble�. � <br /> • Prope�ty Linee • CeMerline of street � <br /> • Outline end dimeneiona ol ell e�cisting end • Indicete Nor�h <br /> proposAd siruclures on Ihe lot • Show eny propased grading chen�es <br /> • Existing and Aroposed utilillos • Show measuremenls M <br /> W <br /> DO NOT WRITE BELOW THIS LINE O <br /> PEFMIT(:ONDITIONS <br /> 1. All cells lor Inspnctlon shall be made 24 hrs. in advance� phone 259•881 5. � <br /> 2. All wark ahell be performed in accordance wlth Ihie permil and currenl City ol Eve�ell DesiBn end Construclion <br /> Stenderds end Specilicelions. <br /> 3. Call Locetion Underground Service 48 hrs. belore you dlg. TOLL FREE NUMBER 1•800•424•5555. � <br /> nc�t v�,ur�...�� , O <br /> ��'� � � <br /> /O �3�� � N <br /> � <br /> a <br /> ACKNOWLEDGEMENT OF CONDI710NS <br /> The undeisiBned owneqxpphcent hereby ag�oes to hold end seve hann� <br /> � less Ihe Cily ol Evnre�t Irom nny and ell clalms lor Aameges, cosls. <br /> expensea, or causes ol action that mey arise because of installalion <br /> anA meintenance ol ihe improvemanl or olher righbof way use hereto <br /> epplied lor end lurther egrees to remove same upon nolice irom Ihe <br /> Approved lor Convtruction Dete City end lo replace pubhc property demeged thereby. <br /> fINAL INSPECTION Dale Dfl�f? <br /> qpproved es Construdad Signaturr,of ApPlicenl <br /> WORK AUTFiORIZED BV THIS PERMIT MUS7 BE STAHTED WITIiIN <br /> e•vvrr[t PUBLIC WORKS DEPARTMENT 1B0 DAVS OF DATE PERMIT IS ISSUED AND THEREAFTEi� IS TO <br /> � 3200 Cedei S�ree� BE DILIGENTLV PURSUED TO COMPLETION. THIS PEiiMIT MAV BE <br /> Everell.WA 98201 CANCELLED BY THE GTV UPON ANY STOPPAGE OF WORK ON THIS <br /> Phnne 259-8815 PROJECT OVER S�0 DAVS DUf7ATION <br />