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i <br /> � <br /> i <br /> ete �-,��s i (��j� )(� � <br /> ,.,,,�.. w,.,�,��.Q,m��".7 ,� ,,-/✓ <br /> APPhcation Por I t��nu u�.n� . _iJ '��_`-7�J 6 <br /> PUBLIG WORKS PERMIT ���°;o„�;,���� : <br /> i.•.env� �es nn�n S __. <br /> Print or Type Gnly Na�a��:P o,�� s ll��' _ <br /> I ��71 �,`� l�7d� `�l''��1�? ' � nn�t'� �l �5 <br /> Ow er Mai mg AAdress City 2�p Phonr�.-�^„, ^ <br /> /� c%lVIJ <br /> Appheenl h7aihn9 Address City 2ip Phonn <br /> Descnbe Propo�ed Work 1��(f�J J��_. ( 4 11 D C_�`'�1 cr �� r/'i� _____ <br /> _��b - /�O th,AL" St- W <br /> Prolect Address bl Nno�n n� � <br /> Altach lour 14)copies ol plans tor proposed worh � �raw to scale entl note Ihe lollowing es apphcabie: � <br /> • Property lmes • Centerline oi street � <br /> • Jutline and dimensiona ol nli c�islin9 anA • InAic2te North <br /> proposed siruclure5 on ihe lo� • Show any proposeA{7radmf� changes <br /> • Er.is�ing And proposed u�ili�ws • Show mcasurements � <br /> DO NOT WRITE �ELOW TFiIS LINE <br /> PERMIT CONDITIONS O <br /> 1.All cetls lor Inspec�ion shell be mede 24 hrs.in advence� phone 259-8810. � <br /> 2.All work shell be pedormed in accordanca with this permit and r,wient City ot[verPlt Design nnd Gonstruction <br /> Standards and Specificelicns. <br /> 3.Cell Locetion UntlergrounA Service 4B hrs.be�ore you dg,TOLL FPEE NUMBER 1-500-424•5555. � <br /> 4 . F1N�' �`iiC+I�U���- TRI lHl= Dk ('JF_IdAV CUT MU�; I� ('�L (�f-'f'f�f7'.'CI? <br /> B�' �THE PI1[+I ll-' WOI�F� S ?NSF'ECI�'lF:. � <br /> S. USE FUC+LIC ❑FAINl1GE 51'STEM AS PFiOVIUEp F-OF G(?�'A13f i �� � f` <br /> 6. AAIY L OT GR/-1DE CH��dGES MUST BE /1FF'ROVED HY TI II_ <br /> PUBLIC WOiif::S IN�iF'ECTOR. � i <br /> 7. L•;�F=F CITY STREETS CL.EFIN AT ALL TIM[S. � <br /> B. .INSiALL WATER FUXES TO GRA(�C AT 7HE [tJ� Of-('�7� , Ii Iu. � InIJ j <br /> 9. hIFlK:E SUFE UI-iIVCIJl11"J /1R� rfiMl'�LCTf-I " f.;ilf'S�D L'�F�.� iif,l�- � I <br /> ur;r��Trir, nri ri{� r. O <br /> a <br /> ncKNowi r o�;� r,nt Nr oi cnNoilioNs � <br /> Thp undersyncA owner!apphcanl hereby ayrces lo hold end Savc hann� <br /> ------- less the Gty ol Eve�ell Irom any and all claims for damn�es. cosls. <br /> � C%pCnSCS. Of CAl1SP5 OI af.il0� Ihdt 1111�• 9fI5P, bPC:IUSF OI I�SI811FlI10� <br />� �� / ' ^ � �/ '9 .� Af1[� f0�If11CI1d�CC• OI IhP �fPpIUVP,f1:Cf11 Of OIFiP.� IiqhPO�-W:iy U5�' hn�n10 <br /> �,,� �t+�.��� � ��1 �. <br /> Approvnd lor C nslruchon Date °��'�'^d lur and lurlhE,r ngrees lo �emove same upon nehce hom Ihr <br /> City anA lo renlacu nublic pruber�Y dameped Ihcre•by <br /> � � � � J �� %/��� � / p <br /> FINALI PECTION Dnle `�_!_c/L:- � �U�/.i;rr�l.0 . .`> �ij1�p <br /> Approved as Gons�ructed �S�phaWre ol Applicanl �U����• <br /> rv��rrit PUBUC WOPKSDEPARTMENT �"wORH AUiHOR12ED BV THIS PERMIT MUST BE STARTEO WIiI�iH <br /> � d; �.CndnrSheel 180 UAVS OF DATF PEFMIi IS ISSUED AND THEREAF7ER IS . <br /> Ev� e�'�.WA98201 BE DI' IGCNTLV PURSUED TO COMPLETION THIS PERMIi MAV F1C <br /> Phont:. 759�8810 CANCEILED BY THE CITY UPON ANY STOPPAGE OF W'ORK ON THIF <br /> PROJECT OVEF7 90 DAVS DURPTION <br />