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oA�e�l��G <br />Appllcelion For <br />PUBLIC WORKS PEF39VIIT <br />Print or Type Only <br />� P��nec'Na���Pn�rcn ���I�(� <br />� NI(Iy GlP� � ����� <br />Punuc WUM� fee <br />To1�l fee R <br />L+u �00� f�e P��E / � <br />8���nce Dua i � � <br />�— / ZGl�F - ,rs� �,�a�i � � i sS _3� �-O3� F�— <br />pN,�A� �—� Mafing Adtlress Cny Lp Phone <br />Applicant <br />Deecribe P�oposed Work <br />Mailing Atldress <br />Oty <br />Proled Addresa (il known) 7�� - ��CG� ¢/J �l _ -� � <br />Attach lour �41 coDies ol plens for proposed wc� rk � D�ew tu ecele antl nole the lollowing as npphceble <br />• Property Linas • Genterhna ol slreet <br />• Oulhne end dimensio�n o� ell e.�ishng and • Indir.ate Nor�h <br />propoeed s��uCiwns on Iha lo� Y ShoW any proposed qradm9 ch�n9i�s <br />• E�isting end prop�is� d utilitles � Show mea5uremen�s <br />PFRMI7 CONDITIONS <br />Phone <br />1 AI' calls �or .nspeclion nhell be made 24 hrs in advence � nhone 259•8815 <br />2. �II work shall be performetl m accordence wtlh thi9 perm�l anA r,urrent Ciry ol F verrit OPs���n an�l Con�,lrucbnn <br />Stenderds anC Specilicetlons <br />3 Coll Localion Underground Service 4B h�s. befo�e yau d�g. TOLL FREE VUMBER 1-800•424•5555. <br />4, ANY GRADING DONF. ON THIS LOT SHALL BE DONE SO A.ri PiOT 'f0 IMPACT TH5 <br />SURROUNDING IATS WITH RAINWATr^.R RUNOFF, <br />5. ANY CURB & GUTTER OR SIDEWALK DAMAGED DURING CONSTRUCI'ION SHALL 9E <br />REPLACED BY THE A�PGiCANT. <br />6. ROOF=fOP DOWNSPOUTS ARE TO BE TIGHT—LINED TO THE PUBLIC DR„INAGE SYSTEM. <br />��.�_G�Y+/'.:L G ` I�L <br />ApUroved f orfs�ruction Date <br />-� <br />.-�o �1 I �� <br />FINAL IN ECTION � __, Dale <br />Approvetl as Cony�n�cted ' <br />evrrru PUBLIC WOiiKS DEPARTMENT <br />� 3200 Ceder Slreel <br />F.verelt. WA 98201 <br />Phone:259�8P15 <br />ACKNOWLEDGEMFNT OF CONDITIONS <br />W <br />� <br />� <br />� <br />O <br />� <br />� <br />O <br />a <br />The undersiqnPd owner/app6cen� hereby egree5 lo holA antl ;eve ha�m� <br />less IFe Cdy ol Evere�l Irom eny end all claims �or Aama;��s cosis. <br />eepenses. m causer� ol eclion Ihnt mny anse bPC' IYP. OI installa��on <br />end mainlenance of the improvemenl or olher nght�obwey use herelo <br />epWiotl fo� antl �urther an�ees lo remove 98mP, upon notir,e hom Ihe <br />Cily nnd lo iepl �ce pubhc pioper Aamaged Ihereby <br />T •�� <br />lurp. ol Applu: Dale <br />WORK AUTHOR12FD BY THIS PERh11T MUST BE STA{iTED W�TNIN <br />180 DAVS Of DATE PERMIT IS ISSUED ANO THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION THIS PERMIT MAv BF: <br />CANCELLED 8V THE CITV UPON A�,JV STOPPAGE OF WORK ON iH�S <br />PROJEC7 OVER 9U DAVS DURATION <br />