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o��Pl�.�l�5� <br />Appiu.dhnn For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />l O �/(J e • /�3 <br />Owner Metling Atltl�e88 <br />C-r <br />Mailing Address <br />Describe Proposed Work <br />Cily <br />1'irLe.•NnrYnP�nrnrvl ���5���� <br />t�ing Oeo� • A s• � � <br />�'��biv Werxe Fee <br />tabiiae � ._ <br />I.a�� �ppl fee P�iE � <br />Painnrr Dm { _2� �� _ <br />i'��Ic� �- <br />Phona <br />Phona <br />�+9 � <br />ProjectAddraes�ilknown) -���- /OG��/��.�SF. L����iZ !�"�` <br />Allech lour (4� copies ol plena for proposed work - LrTw to sr�ie ;md ��nir� Ihe following es epp�lcehle�. <br />• P�operly L�nes • Cente�line ol atreel <br />' • Outlina end dimansiona ol ell cxisl���,ri anrl • Indicate Norlii <br />propo9ed 5lructure9 on Ihe lot • Show nny propoead gredmg chen{�es <br />• • Exishnc� nnd proposed u�ili�ies • Show mensuremenls <br />PERMIi CONDITIONS <br />1. All calls lor inspechon shall be made 24 hrs. in edvenCe � phone 259•8815 <br />2. Ali work 9hell be perlarmerl m nccordence wlth this permit nnd cunenl C�ly u� F vr!��+11 �es�yn anA Cnnslrurt�on <br />Slendards end Specificetions. <br />3. Call Locntion Undarground Saivice 48 hrs 6elore you diy TOLL FREE NUMBER 1•BOO•42A•5rJ55. <br />'S�. E�ris �..di� SiQ�'tJl�G t is NEr,i � s�,vva��,o � F o � .�.vy <br />S�DEealdtK O�(' GC/RG' r �'�'TE:e vdM�Il+Fp a'/t'/N(� Cryl<(Tm', <br />SNdLL O'E '��E�r.',ACF� dy 7.vF An•�iiL4�/T <br />S, �OOf �tc%JS/'n�rT( Si/ncL �E T:.N.-- �i.t:fi) T�.� <br />CU.c'd v.zd.N s . <br />�, G�eao..�.G o.v T-�:: <br />T� Tnas>n �; 7.� f <br />� / lA; - !! �/ , <br />��i7� <br />App�ovedlor <br />FINAL INSPECTION �� � <br />ApProveA as ConstrucleA <br />rvPrvll PUBLIC WORKS DEPARTMENT <br />� 3200 Cedar Sheel <br />f vnrelt. WA 98201 <br />Phone�.259-8815 <br />[c•.T C'.v�a[ !if- /il�.v(- Sa�� AS� nl(�r <br />S�•t'i>��i.n�i.�,�.', L2%�t �i�„�.�. t'�,n,rc.�t-'F',- <br />� <br />Dete <br />�8�9 <br />W <br />� <br />� <br />z <br />O <br />� <br />� <br />O <br />a <br />df FIJi 1N,'I I_ftGll.tf I`!I �)1 (�.UPJUIIII)NS <br />I��,� �inJ.�rsign�;tl ownei/apphcant hwehy ngryes to fnld ind save harm- <br />����. the City ol Everelt Irom any and all cleims for dameges, coets. <br />o.penses, or causes ol aclion Ihat mny arise because ol Inslalletion <br />and meinlenence ol Ihe Improver�ent or o�her nghl�ol-way use herAto <br />applied lor nnd Iwlhei ngrees to remove aeme upon notir,e Irom the <br />City end lo replace puh6c proper�y dBmAged �heraby. <br />� � > <br />Sign:tlure ol ppl�r.a� L �p� <br />WORK I1UiIlORi.'[ � THIS PERMIT MUST BE STARTED WRt11N <br />180 DAVS O� DATE PERMIT IS ISSUE� AND THEREAFTER IS it� <br />BE DILIGENTLY PURSUFf� TO COMPLETION. THIS PERMIT MAV P� <br />CANCELLED BV THE CIiY UPON ANY STOPPAGE OF WORK ON ir11ti <br />PROJECT OVER 90 DAYS DURATION. <br />