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Date�i3�Y� <br />Applicetion For <br />PUBLIC WORI�S PERMIT <br />Print or Type Only <br />Ownar <br />Appllcant <br />� �� <br />Adtlreas <br />'ded;ng Addresa <br />�I <br />Gty Lo <br />r,mo� w�,w• re�m�i . O � - � � <br />BIOp [lepl � ���.f' <br />v�eiK wed. ree s <br />i ol�l iaa <br />lei� �ppl Fae V�id i <br />9�IsnceDue i �Ca� <br />�'3 � �% <br />yS ,"��3- U <br />Deacdbe Pr000aed'Nork _ S �^/1 � � O ��� . �� C � <br />< <CA �Rnt_ <br />� � �1 - <br />Proiec� aarreas pi knownl '��� -/��o � �f �� E <br />Ah.�ch lour (4) copiea ol plene lor proposaG wo�k � Draw lo scala end nole the lollowing es apphcabie. <br />• Prope�ty Linea • Cc�terlina ol strrr�t <br />• Outune end dimanaions of all eMistiny xnd • Intlicate Ncrth <br />proposed slructures on the lot • Show nny pioposed yr�dmy chanyes <br />• Ex!sfiny and proposed u Ilities • Show mensurem�rt; <br />PEF1.11T CONDITIONS <br />1 All r,alls for inspection shall be made 24 hr6 in advance � phone 25S•8815 <br />2 All work ahall be perlormed in ncco�danr,e wilh ihig permtl end cwranl Ctly ol Fvxrell Design flntl Construchon <br />Stnnderde end Spacillcations <br />3. Call Location Underg�ound Cervi�e 48 hrs. befora yau Aiq. TOIL FREE NUMBER' •800•424•5555. <br />4. This lo[ depende on a lift e[a[ion for sanilary aewer service. 1'he C{[y hae <br />no[ accepted Che lift stetion for operaLion and main[enance ae ot th�A date. <br />Occupancy of reaidence will not he allowed until [he City accepta the llf[ <br />station. <br />:�. Down epou[e from the houae a[e to be tigh[-lined [o [he curb drain. <br />b. Any greding of [hie lot le [o be don^. so ae no[ to impac[ [he adjoining lots <br />wi[h rain-water run-off. <br />1. Sidewalk ie new and unbroken. Any dnmaqe [o i[ will requlre replacement by <br />the applicxn[. <br />/y- <br />Date <br />-! v� �o <br />Approved es Conslructed V � <br />everell �'UBLIC WORKS DEPARTMENT <br />� 320G Coder Street <br />EvaretL WA 98201 <br />Fhona:259�8815 <br />� <br />O <br />� <br />� <br />O <br />a <br />ACkNUWLfDGEMEn,T Of CONGI110NS <br />The iindr.rsiy�iad nwneriapPlicanl herehy ayrees lo hold and save Y.j.m� <br />less Ihe Gty ol Everell horn eny and xll .Ieime for demepes, costs. <br />expen5es, o� cnuses ol ntlion Ihat mpy uriee beceuse ol installntion <br />and maintenxnce ol ihe improvement or other righPol-wey use herotr <br />epPlied fOr end lurih?r eq•ses IU remoVe 9Ama upon nolice lroci Ihe <br />City and to ryplece pubhc properly tlemegad �hereby. <br />�, � <br />C/ � <br />�-' �-t--- _ �:� � /�. <br />SigrRilurc ot App'�ce,Rl . GBIe � <br />WORK AUTHORIZED B� TH�5 PERMIT MUST BE STARTED WITHIN <br />1d0 DAVS OP DATE PERMI; IS ISSUED AND THEi:EAF7ER IS TO <br />BE DILIGENTLV PURSUED TO COMPLETION. THIS PFRMIT MAY BE <br />CANCELLED 6V THE CITV UPON ANV STOPPAGE OF WORK ON TH�S <br />PROJECT OVER 9U DA'IS DURATION. <br />