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Date �'�� <br />ApphcaliJi� f�r <br />PUBLIC WORKS PEfiMIT <br />Print or Type Only <br />'� � I (_� <br />Mai6ng Addr.±s5 <br />r / . F' 4_ <br />��.,��i.. Wm�� Prrmil • v � ' /�S <br />m,. o�o� . __ �,.'�� ��C�-_1"�� <br />_ _---- - -- <br />r.�,im� Wn���Fee <br />:oin�lee � _' _ . <br />Ln1f 1Ppl f�! PAcI f <br />�AA��nr� pun { _� _ <br />- � - <br />f'hone <br />- - ?�3-�)�; <br />Apphtenl Maihng AtlA�ess Cdy Zip Phone <br />�� <br />Descrihe Proposetl Wo�k <br />Proiect Adtlreas lil knowni �2z� � ���,� �'� �C, � /,(/ <br />Attach lou� (41 copies ol plans lor p�oposetl work � Draw to scale antl nole the 'ollowiny as app6cabi�� <br />S P�aper�Y Lines <br />O OuUlne end d�mencions ol nll e.islmq an�t <br />��onosed s����cw�Ps o� Ihr lat <br />• Exisling and proposeA uhlrties <br />• Genlerline ol slreel <br />• Int�¢a•� Norlh <br />• Slmw �ny prnpus��t1 q'��dinq rhunyn� <br />• Shov, nr�asuremenrti <br />THIS LiNF <br />PERMI7 CONDITIONS <br />1, All cells lor Ingpecticn shall be mnde 24 hrs. m ndvence � phone 2S9•88i0 <br />2. All work shell be pedormed In eccordance wlih Ihls permit nnd current Cdy of Evei�tt D��siqn and Construrnon <br />Standerds and Specilicetions. <br />3. Call Locetion Underpround Service 48 hrs. balora you dig. TOLL FREE NUMBER 1•800•42d•5555. <br />il oS���.�, cw,:..� , <br />�'� �.� <br />�� <br />4�9Gc1.�+i d,1e. �ti...' �'� L�e�r✓,(vr-� <br />..� �� �� �e ��,vl� �P.o �� r3G� <br />�- <br />5S Qx� �%�,u.�- �,✓ .�i v'/l�vu..n ��c.af� -C�C .Q'��+zr,e�' <br />� �,4� `'�c�l�'. air�3- �K��"'v �� .�, �oz��,� . <br />� �� ��y �.� ,��. ��a.�.��.-. <br />� <br />i— <br />� �y s <br />ApP'ov lor Conshuction ate <br />� � � —.___/�� <br />�� � <br />N I SP CTION Me <br />Approvo�' as Cnnshucted <br />Nvrn•t� PUBLIC WORKS DEPARTMEN7 <br />� 3200 CeCar SVenl <br />Everel�. WA 9B201 <br />Pnonr, 259�9910 <br />ACKNOWLEOGEMENT UP CONDITIONS <br />� <br />� <br />� <br />� <br />0 <br />� <br />N <br />O <br />a <br />ihe unAersigned owner/apPhtanl hereby a9rees In hold and snve h:i� ��� <br />less Ihe Cdy of F.verel� Irom any and all cla�ms lor dampges, ro�•�e, <br />f!�pC�S(15. O� CPl19P.9 O� A[IIO� IhHI IOTy OnSP bNfBUSE OI I�SIAIiBIii��i <br />and main;enance nl ihe imProvemenl or olher rinht�ol�way i�se• h�v��l�� <br />�ppl�,ed lor nnA furlher ayrnes lo remove same uPon noticc hr�ni tri�� <br />i1y and Io replar,e puhhc prone�tY dameged Ihere�i <br />� // � <br />1, �� .�-:��� �c. .� � �� <br />i-- <br />Si9nnlure ol Appliconl � �L������ <br />WORH AU7HORIZ[0 BV THIS PERMIT MUST BE STAFiED Wlli-IIN <br />180 DAYS OF D��TF PERMIT IS ISSUED AND THEFEAFTER IS 7�-� <br />BE DIUGFNTLV PUR�UED TO COMPI F�ION THIS PERMIT MAV Rf <br />CANCELLED BV THE CITV UPOIv ANv S10PP4GF OF WOiiK ON Thn`, <br />PROJECT OVER 90 DAVS DURATIO�I <br />