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Datet�l�,�Q��1C , <br />Appllcation For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />�\ �J N 1�1-�_ <br />Mailing <br />Meilinq <br />Describe Proposatl Work ��� <br />Pro�ect Addreee 111 Nnown� <br />Pun��r Wnrxe Perrnu • '�`� � �� � <br />r <br />a��n Den� • <br />vunnrwo�x�fre = - <br />fotel fee <br />less Appl Fep P��d S� <br />Be�ence Oux �U �G <br />f_ i <br />2ip <br />ZiP Phone <br />- /D�i y" C'T S E. <br />Attech four (4) copies ol pleea lor p�oposed work � Drew to acele antl note the lellowinp es auo��cabie. <br />• Propar�y Lines <br />• Outline end dlmeneiona cl xll e*is,�ng end <br />propoaed aVuctures on ! �e lot <br />• EMieting end proposed WJilies <br />PERMIT COYDIT�OP!S <br />• Centerline of sUrel <br />• Intlicate North <br />• ShOw eny p�npo�eA grad�ny chnnges <br />• Show mea9uremenl5 <br />1 All calls br inspeclion ahall be mede 24 hrs. In advance � phone 25A-8815 <br />:. All work 5hell be perlormed in a�cordence wRh Ihis permit end r.ui rpnl Gly ol Everelt Design anA Construr,tion <br />Slandxrds end Specifications. <br />3 Cell Locetiop Und�� rou Service 48 hre. 6ebre you tlig TOLL FR E NUMBER 1•800•424•5555. <br />/I tJn �] <br />`i , 7"''( � 5 fn.... opc.,..�� .,,,� GchJ-� i c6tn� , <br />S. y`"� � c...�^a., � - � �-t�„ � �.�.-. 1.,.�„� h.�..` <br />�O - "x^.adc� � Ji— S.> a.� <br />u <br />�,.u'f' � i.�..--.��.�.�/'�o.w�n-.n.-�,.�:.� �u '�s . <br />PUBLIC WORKS DEPARTMENT <br />92U0 CedB� $Irppl <br />Fu�re���. WA 98701 <br />1`hnnP 259-RPI, <br />n� kNnw� r nanni Nr ur cuNn�nonis <br />W <br />� <br />� <br />� <br />O <br />ihe r�deisigned ownevTPPhcflnl herehy nt�ree.n to holtl und snvP harm� <br />i�•ss Ihc City o� Everell Irom qny entl all cleims tor damaaes, r.osis. <br />eKpenses, or ce�ses of aclion thel mwy ense 6eceuea ol Inslaltnhon <br />and maintr.nance ol Ihe unprovemant rn olher righl-o��way use he�elo <br />Bpphed lor nnd Iurlher agrees to removc seme upon no!�.�•a Irom Ihe <br />Clly nnd lo rnplace pubhc r.iopeny damnged thereby <br />Signalu�� t ///M� `~L� DzU, <br />WORK AUTHORIlED EV THIS PERMIT MUST BE STARfED WiiHIN <br />1B0 DAVS OF DAiE PERMiT IS ISSUED ANO THEREA'TER IS TO <br />BE DIUGENT�y pi�qSUED TO COMPLETIQN TI115 PERMIi MAY BE <br />CnNCELLED BV TN .,iTV UPON nNv sroPPnr;E O� W0�7k (1N IMS <br />P�70JECT OVFR 9� li yS DURPT1f1N <br />