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Date �� a ' _ <br />Pnplicntion Fnr <br />�41BLIC W'ORKS PERMiT <br />Print or Type Only <br />Puppc Won� Permil � `�'-� � `��' � _ <br />BiEp D�ol • 'f iir .3 _ <br />Pueuc wo,t. Poe e <br />Tol�ifos <br />lap �pDl ise P� C: <br />B�I�nreDue f <br />�ef�o Con��, rh�. ��n�� �s f�A�E.c�� s�, �P q'�'/S_5- 363-U3/H <br />Owner Mel{ing Atltlresn Gry Ilp Phone <br />Same <br />Appli�ent Mailiup Address City Zip Phone <br />Dee: ribe Propoend Work <br />Pro�ectAdd�oeslilknown� �Of��7. _�.?/—/U�o�h��. .S.E. _ <br />Atlach four 14) copies ol plena lor proposed work - Oraw to acxle and note Ihn lollowing as epphcat�le <br />• Property Llnea <br />• Outllne and dimenalons o� ell ezis!ing end <br />pfOp059d BINC�Of@8 OC IhQ 101 <br />• E�istin� end proposed ulililies <br />PERMIT CONDITIO4S <br />• Centerline o� street <br />• Ind:cxle North <br />• Show nny proposeA yrad�ng changes <br />• Show mea�uremenis <br />t Au cae:, lor inspec�ion shall be mar:e 24 hrs In edvance phone 259•8815 <br />2. All work shell 6e pe�formad in eccordence wilh tM1is nermit nnd cunent Cily _ cverelt Deslgn anA Cons�ruCbn <br />Standerds nnd Rper.IGcetions. <br />3. Cell Localian Undergtound Service 48 hrs. belore you dig. TOLL FREE NUMBER 1•300•1'1�J•5rJSS. <br />4. Existing sidewalks are unbroken and in new condition, the upplir.ant <br />is required to replac� nny sidewalk damuKecl duri�g construction. <br />S. Roof down spouts are to be tight-li:red to existing curb dru�ns. <br />6. Any grading of the lot is to be done so as not to impa�t the surrow�ding <br />lots with rain-water run-off. <br />r% JC�.E 1�.�rr�'<'__�GC� N <br />ApF�oved lor Constructlon nle <br />FINAL INSPECTION � - De�e <br />npproved e � Constructad <br />evwrtl PUBLIC WORKS DEPARTMENT <br />� 3200 Cedar Sireel <br />Evarelt. WA 98701 <br />Phone 259�BB15 <br />AGKNOWLEDGFIAFNI O� CONDI110NS <br />W <br />� <br />� <br />� <br />� <br />� <br />� <br />� <br />O <br />a <br />7he undersiynpd owner/applicqnt hpreby n9ree5 io hold and savn harm� <br />less the Cdy o� Cvarett �rom eny and all cleims lor .in�.-aqes, costs. <br />expense�, or causes o� ection ihal mey arise baceuse o� instollation <br />and maintPnance of Ihe impwvamenl or other righbobwey use herelo <br />epullv,d fa end lurihe� ag.aes to remove snme upon notice irom Ihn <br />COy and lo replece public property demeged Ihereby. <br />�` f> /'/ " /�_�•�aJ <br />Signelure ol Applicant Defe <br />WORK AUTHORI::ED BY TIiIS PERMIT M11ST 8E STARTFD WITHIN <br />1B0 DAVS OF DATE PERMIT IS ISSUED AND THEREAFTE�i i5 TO <br />BE DILIGFNiLY P�riSUEO TO COMPIETION THIS PERMIT MAV BE <br />CANCFLLED BV THE CITV UPON .4NV STOPPAGE OF WORK ON THIS <br />PHOJECT OVER 90 DAVS DUflF.iION <br />