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oate �' ���� <br />Applicetion For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />Pupbc Worb Permil �• —�/-/-���� <br />BNIp DaO� � ___. _// �/rJ_— <br />r <br />PopLc WerM�fe! , <br />Ta1si iee <br />Les� �00� �ee Pe�tl � <br />BH�nc� Dua f <br />c�iy <br />Deecribe Proposad Work <br />Pro�eel Addreae pl known� <br />Atlach lour (4) coplea ol plene lor proposed work - Draw to ecele end note Ihr, lollowing as epplicable: <br />• Proparty Llnea <br />� Outllne end Almensions rl all exiatlnp and <br />p�opoaed elructures on Ihe lot <br />� Exleling and propoeed utililles <br />� Centerline ol slreel <br />� Indlcale North <br />• Show eny proposad grading changee <br />• Show moasurementa <br />Phone <br />PERMIT CONDITIONS <br />1. All celle lor Inepactlon ehell be mede 24 hre. In advence • phone 259•8810. <br />2. All work shell be perlormad In accordence wllh thle permit and current City ol Eveiett Deelgn end Conatructlon <br />9tenderAe end Spaelficallone. <br />3. Cell Locetion Underpround Servlce 48 hra. belore you dlg. TOI.L FREE NUMBER 1•800•424•858�5. <br />�!/�a tdo-� f.�it...�,/ if//ef ,FtY,vc,u�' <br />Approved for Constructlon Dete <br />FINAL INSPECTION Dete <br />Approved ae Constructed <br />rverelt PUBLIC WORK3 DEPARTMENT <br />� 3200 Ceder Stroat <br />Everelt WA 9B20t <br />Phone� 259-8810 <br />��1..,�"" �'ov-�i <br />2 -20- 9/ <br />ACKNOWLEUGEMENT Of CO�JDITIONS <br />W <br />H <br />� <br />I� <br />� <br />The undersi9ned ownr.r/xpphcenl hereby egrees lo hold antl save harm� <br />less Ihe City ol Everell Irom any end ell claims lor damagos. costs. <br />eMDenses, or ceuses ol ection thqt mey arisa bacauee of inslallallon <br />and mnintenence ol Ihe improvement or other nghl-obwey use herelo <br />eppheA lor anA (uriher a4rePs lo remove same uPon nM�ce Irom Ihe <br />Cily B�A �O fPpIaCP nlibhf. �fOpP��y ddrtlA[JEd �hP,�ehy. <br />Sip�unure al Applicanl DAIe <br />WORk AUTFIORIZED BV THIS PERMIT MUST BE STARTED WITHIN <br />190 DAVS OF DATE PERMIT IS ISSUED ANO THF.FEAFTER IS TO <br />9E DILIGENTLV PURSUED TO COMPLETION TNIS PERMIT MAV BE <br />CANrELLFD BV THE CI7V UPON ANV STOPPAGF OF WORK ON THiS <br />PROJFCT OVER 90 DAVS DURATION <br />