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Date 0 i <br />� <br />Applicetion For <br />PU�LIC WORKS PERMIT <br />Piint or Type Only <br />Po�4c Wcrh� Permil • <br />5 <br />Biei Uoo� . <br />P�.bAc WmM� Fee <br />Talel Fee s <br />LNC� �ppl F!e Pe�d S <br />B�bnce Due S _ t�� �C� <br />ryi on / <br />Applicent <br />Describo Proposed Work <br />Projecl Address pf known� _ k� U h " <br />NtlC: 3S5 <br />Z�P Phona <br />Attech low (q) coplas of plens fo� proposed work - D�aw to scele and note iho following xs applicable� <br />• Proparty Linos <br />s Outline end dimensions ol all existinq snd <br />propased shucl�res on ihe lot <br />• Exis�ing end proposed utililies <br />PERMIT CONDITIONS <br />• Cente�lina ol streel <br />• Indicate Norlh <br />• Show any proposed gradiny changes <br />• Show measuremenls <br />1. All calls lor inspecuon shall be made 24 hrs. in ativance � phone 259-881 5. <br />2. All work shall bo perlormed In accordance with this permit and cmrenl Cdy ol Everott Design and Construclion <br />Stantlards and Sper.11icetions. <br />3. Call Location Undorgrouno Service 48 h�s. belore you dic� TOLL FREE NUMBER 1•800•424•5$55. <br />��/L /.3"[ 'ri�— � �l r. <br />App�oved for Con ruclion alo <br />� - 7'z3'8CD <br />FINAL INSPECTION Date <br />Approved as Constructed <br />evrrctt PUBUC WORKS DE; :RTMENT <br />� 3200 Cedar Sfreel <br />Everelt. WA 98201 <br />Phonc:259�BH15 <br />ACKNOWLEDG[A1ENT OF CONDITIONS <br />� <br />O <br />■ <br />N <br />O <br />a <br />The un iers�yned owne�/applicanl hereby agrees to hotd and save haim� <br />�^ss the Cny ol [veretl I�om any and all claims lor tlamages, costs, <br />, tpenses, or causes ol action that may arise because ol inslollatiun <br />and maintenar�ce ol Ihe nnprovemenl or other riphPobway usc herelo <br />applied lor and lurther ac�rees to remove samo upon nolice Irom the <br />CJlY�n�to replac� puylic pmperty damaged Ihereby. <br />�vv�fiK AUTHORI:ED BV THIS PERMIT MUST BE STARTED WITHIN <br />1b0 DAYS OF OATE PERMIT IS ISSUED AND TIIEREAFTER IS T(1 <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAV pE <br />CANCELLED !?Y TH[ CITY UPON ANY S70PPAGE OF WGRY. ON THIS <br />f'ROJR;1 OVLR 90 DAYS DUR�1'ION <br />