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,� <br />Date <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />,1��,�� ,� <br />DescriCe Proposed Work <br />Prolecf Addresa QI knowm <br />� <br />Maihng <br />MBlllfl(J NOOfPfiS <br />��T% G�-C <br />r,�ry z�o <br />City Z�p <br />� ���n��cwa,..r � <br />I Aiac onn� • �'�—LL�� <br />Pueuc WorweFee <br />imni fee 5 <br />�.rxapN vnnva�a S <br />n.r.,��� n,�� S <br />Atlach lour (A) copies ol plans for proposed wmk � Draw lo scnle and note ihe lollowiny as applicalile� <br />• Property Lines • Cen�erline of streel <br />• Ourhne end Aimensians ol all e�isling and • Indicate No�th <br />proposed sinictures on the lot • Show any propo5ed giadiny changes <br />• EMisting and proposed ulilities • Show measurements <br />Phonr <br />Phonr <br />P[RMIT CONDITIONS <br />1 All calls fm inspeclion shell be made 24 hrs. in aAvance � phone 2.ri9•881 5. <br />2 All wOrk Shall Co perlo�med in eCcoidance wilh t��s permi� anC currenl City ol EvnrMt Design anA Conshu�tion <br />Standards erd Specilicnlions. <br />3. Call Loca�ion Underground Service 49 hrs. belore you dig TOLL FREE NUMBER 1•800•424•5b55. <br />/'��%-i','.,_ !ti(��'(_; <br />Approv�•d inr ConVrudion <br />FINAL INSPECTION <br />qpproved as Conslruc�ed <br />perr�•It P�BLIG IYORKS DEPARTMENT <br />� 3200 Cedai Street <br />Cverelt. WA 98201 <br />Phone 259�8815 <br />, ,'-,�i�,. :ti�.'�T �''�.jli:.�'t!J .��i�"��' <br />. �y� .�� ` <br />/ <br />Datr <br />DaI? <br />ACKNOWL[DGEMEM iJt� CONDITIONS <br />W <br />H <br />N <br />� <br />O <br />� <br />N <br />O <br />a <br />Th�� under;iunr.d owner/apPhcant hereby egree5 t0 holA nnd savr h�ann� <br />irss the City ol Everelt Irom any and all clalme for Aamages costs. <br />c�penses, or cau5e5 0l aClion Ih�l may anse because ol mslnllatinn <br />and mamtenence ol Ihe improvemenl or other nghl�ol�way use herMo <br />apphed lor and �urlher agrees to remove same upon nolice Irom Ihe <br />City nnd to replace pubhc property damaged ihereby. <br />Siynature ol ApPhcan� Dale <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITf11N <br />180 OAVS OF DATE PERMIT IS ISSUFD AND THEREAFTER IS TO <br />BE DILIGENTLV Pl1R5UED TO COMPLETION. THIS PERMIi MAV HE <br />CANC[LLED BY THE CITV UPON ANY SiOPPAGE GF WORH ON THIS <br />PRO,�[CT OVFR 90 DAVS DURATION ,(� <br />