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S1 <br />� <br />i <br />�y�. <br />r)VlNI. R r�nhlf <br />mm�nnnnrss <br />PUB�ic woRKs <br />PERMIT <br />��UHLIC WOqKS DEPAHTMENT <br />3200 C�dar S!reot <br />Everolt, WA 98201 <br />14?5� 267�8810 <br />.�� �. 'oE .8+�•fli i-I' <br />',1"FJT�'�li YN <br />rrio�,[ , �, 1510 <br />�' inxrnar,c�ic� -. _ _ <br />' , � �) I ill��i�? ili.__.. <br />'i Itt S�:HIPTIUN OF <br />PIIOI'nSED WORN �'�..i �j� A{F <br />Pf RMIT CJNDITIONS <br />�a�p4= <br />APPLICANt NAME <br />AN[)ADDR@BS � �.'„ <br />rnoNE <br />�alrt <br />PuWK Works Permil a � ��, �: . <br />Buildmg Permil �' � � <br />Plemm�g Relerence N <br />Public Works Fee S <br />_6uweMee S -�- , '11 \ <br />. <br />/ <br />PROJ[CTADDRESS � <br />_�iu �e� Ft ��r� -- i <br />1 All calls br inspection shal� be made 24 hours in edvanr.e. <br />? All work shall be perlorm�d in accordence wi�h �his pennit ,md runnnl Gily ol Evornll Dosiqn �nd ConsUur,lron <br />Standards and Specihcations. <br />3 Cell Locn�ion Undergiound Sernce 48 hrs beloie you c6y TOLL FREE NUMBER 1-800-424•5555 <br />� . . . . . . . � � „�„ i �. i �, � � i . . . . <br />s y��.j.r ,. �. <br />_onne�t rooftnp drnmapnnt� rn ihP drnfnAgn �yetn�n prnv��lecl ���• th�a ln!''; c-Y� �, <br />'.'ha contractor: suet eeet vith Lhe Puk�llr IF,�ka Ina��tr,,e tc die�-usr(y�p7��ir.� <br />nagf cuutfnp pi�oc tc; l�e�inn�np the pinject. * • <br />�nelal] or„ni�m ,•.�ntin] u.;anuiRn . ..rr , L, <br />�,wr r.yty ��( !'v c Staniar�n for Pwi� ���4,' <br />��11 P7fCHVNL!�/I �mit�ria] fi�en (b110<IPi]bfl� nidPwrlk �n�l drivwry� ehnll t�e hn�ti, <br />pio��d, pr�Alfted :�ite. W� ��aering of materlal ia allow�f nn thi^ Luild�n; `, +�,'' <br />"� d�ct, mu�i, ri�ka nc �:lebria to he t�ncked onto ioadvay. '" <br />Cqv�� dc 1�•�•Wey f��,e t.he L-ont p:�y�.rty line „ut t,� th� niceet pav:na�'�. , <br />Contacr. thr MI�;iL7LO Y�ter �intr�ct foi rc�nnecting prrovSei�m^ ���i �ri�, � <br />. _ . �� ,n+ , ., ... ,. . ,. <br />N O M • . <br />O � <br />O� <br />� i.'ji.ii-i'::.c.��{; .L-/� �� -.i:..` <br />Ml�mvealoiConllrucl(di�—� �' ,� <br />�� , . r..' /` -�+�--T-L--+---�� <br />NSPk (' I IUN <br />Fppioven .0 Cansl�uc�oif �dte <br />3 -/ 7— �/ <br />TO FO �TING � �� 1� <br />ACKNOWLEDGEMEN7 OF CONDITIONS <br />The untlersigned owne� uppl�wnl hcreby agreos lo hold nnA <br />save harmless Ihe Cily ol Everell lrom any entl all clxims br <br />tlnmages. eosls, ovpanses. or cxuses ol eelion ihnt mny nnse <br />Uecause ol inslallFilion xntl mnmlennnce ol ihe impmvement or <br />othor nghbol�wxy use here�o npphad br end lurlhor ngreos to <br />�emuve seme upon nol�ce Imm Ihe City and b replace punhc <br />property tlnmagecl lhereby <br />slgnb�ure d�lpjNiplm , � Dale <br />WORN At1THORIZED PV lHiS PERMIi MUST OE STARTEn WIININ tIN7 DI1YS OF DATF PERMIT IS ISSUED RND TNERENfTEN IS TO 9E [11�I�ENTLV PURSUFD <br />i0 COMPLEiION 7HI5 PERMIT MAV PE CANCELlEO BY TME CITV UPON ANY STOPPAGE OF WORK ON THIS PRWECT OVER 90 ORYS DUR�iION <br />fPWPllal D�T�N,1R INr. <br />W <br />� <br />'�A <br />V/ <br />W <br />O <br />� <br />Z <br />O <br />r <br />O <br />a <br />