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PUBLIC WORKS PERMIT <br />('ih u! fvefftt f��tdir, W�n� ti Oi�{::i�lmnnl <br />JZ00 Cedar Slr�et <br />EvereN, WA 98101 <br />�425) 2Ci7-8B1G <br />OWNER NAME AND ADDRESS: <br />NGUYEN MIKE 8 TPM61Y <br />23524 JSTH �VE W <br />f3f2�EH WA 98036 <br />PHON[: 4257G000'_9 <br />TAX PARCELIDI! 003949000G1000 <br />DESCRIPTION OF PROPOSED WORK: <br />N[W SINGLL' 1�11�;11LY RESIDENC[ <br />SAM1�tE S[1' 01" PLANS AS C 1410-00' <br />Date <br />Public VJorks Permd 1J <br />6wid�nq Permit # <br />Plann�nq Reference # <br />Public Works Fee $ <br />Other $ <br />APPLICANT NAME AND ADDRESS� <br />PHONE <br />SIT[ AODRESS <br />1�27 c� <br />12/16/?014 / <br />PW 1412-OG' <br />C1410 OOB, <br />REVI114-004 <br />5 65 00 <br />PERMIT CONDITIONS <br />1 All ca'�s for inspection shall be made 24 hours �n advance <br />2 All work shall be Ferformed �n accordar,ce w�th tre perm�t and curen� GP� of Everelt Des�gn and Conslruchon Slandaids <br />and Speu6caUons <br />3 Call Locaho� UndergrounA Sernce 49 hrs betcre you dig TOLL FREE NUMBER 811 C;. <br />4 Per approved drainage plan dated 12i 15-�014 n� � •.• r <br />5 ,Aa irIN4�IL� , ��CL162 ,-, .. ' . , <br />� .. � c�� n ,-� �_�:�` <br />6 Inslail eros�on conlro� measures as determ�ned by the Pubi c�neSlfslw'to� �1 ,as,s�if,guK*�, 5{14w,Dales', <br />�r�7�, ��._ -- , , <br />swa'es or erosion blankets • � � : �^ � ; <br />7 All excavated matenal from toundaLon, sidewalk and dnveways sh,i!I 1��� h,r,,Ie�1 to an aF proved:'ja�rm�lted sd� <br />No wasUng of matenal �s al'owed on lh�s buddmg lot --. <br />8 No dirt mud rocks or debr�s lo be tracked orto roadway (A <br />9 No buildmg matenals to be stacked on s�dewalk/roadway and s�d�aiF'roadway to be kept clean and open for <br />pedesUian !ravel r <br />... J .. .n �.. <br />,� • � : <br />1� M M fR l.l <br />: .., . � �: Y' : .. �-. <br />,� •• � .�,�,r;l^��.��'�'4'� <br />=�ri-'�'=;.- ���- � - . • <br />..,UJ7�:`r_r�:� is8=��:%?£.,.-.�'�S;�i <br />TO POSTING "'� <br />-��� � -�-� �- <br />!?ppro d f Co s!�uct�o o Date <br />` ��� -�-�6-�S <br />F AL INSPLC II N Date <br />Approved as Constructed <br />ACKNOWLEDCFMI-NI OF CONUIiI ��!'�� <br />I P�c unders�gned owner/appDcant hereby agn•��, u�� �-;u ,ui�t <br />save harmless Uie Gity ol Cveretl Irom any and �i�l �_Im�ns ���r <br />darnages. cosls, ezpenses. or causes o� acUon Ihat may ai�,�• <br />br�ctwse of installation nnd mainlenance ol lhe improvemont <br />or elhcr nyht�of�way use I�e�etu apphed lur aml lurihr� �n�<<•���, <br />In remove same upen noucc from Ihe Gly and tu rr�p�.i�. �: <br />puUPcprop��rydamaqedR�.eicby � <br />— ' 1 — <br />S�gnature ol Appl� .a�n Dale <br />4'IONN AUIHOHILED BY IPIS PtHP11T i�1115T BC S�AR�CD Ylll MI�I IHOI�AY�. ph f'� IF VFNMII K ISSUfD AtlU 'rlf P�A1 If R IS TD OE DII IG^�11 v <br />��t.nq�pl�1U(r�'•tr9rrwh n9tirrir�tl��•nvNtrp-n.lnrr,Br�H�r�t,i�r�•,anr�.r,i�rtr.��r�,� r���n.��:uq��r•ornrir.ir�,�,^;,.�.��,�",�„ . <br />