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Date���j V � <br />Application Fo� <br />PUBI.IC WORKS PERMIT <br />F'rint or Ty�e Only <br />Put�uc Wor1s Peim T"�/'�� <br />B�ap Oept • �• y)Y �/ ,-- <br />PuolmWo�wnF�e s <br />iot�l Fan <br />Lrfe �pPl fee Paid S <br />9adnce �ue <br />"_ !!,dL���-' J�, ik',�,C`�C��t'� -1,'%-1-�r--1�-- '�?`''''.�[ �. �`r�', -�,�f(s�' <br />Ownrr Mailing Address Citp Zip Phone <br />_ . . . � , i � � , i L . � _. '"1 t t <br />/1 ^� <br />Oesr.ri6e Pronosetl WorF <br />Project Address �it known) <br />c�ty <br />^',��' . =;�i�r7�)r� <br />Attach lour 14� copies of plans lo� proposed work � Drew lo scele and note Ihe lollowing as apPlicable; <br />• Properly Lines • Cenlerline ol streel <br />• Outllne end dlmensions ol all e�istinp nnd • Indicnte Narth <br />proposed sirvctures on ihe lot • Show any proposed gradinn changr,s <br />� Ezlsting end proposed utilities • Show measuremanis <br />ne <br />PERMITCONDIiIONS <br />1, All calls lor insoecfion shall be mede 24 hre. in edvance � phone 259•88� rJ. <br />2 All work ;hall be perlormed in accord.mce wilh Ihis permi� anA c�inrnl Gity of EverMt Dr,si9n and Construction <br />Standards and 9peciGcalions <br />3 Call Locahon Under�round Srrvice 4H hr, beloie you q�g TOLL FREE NUMBER 1-800•424•5555. <br />�Uj3'L.�C c����;r'/�_s /�6�;'/rii� i7�%' ,�� y'r;•.riG' /��' ,�,•� � <br />Appraved lor Const�uction <br />ACI<NOWLED(lEMCNf OF CONDI710N5 <br />W <br />� <br />� <br />� <br />O <br />r <br />N <br />O <br />a <br />The unde�s�gned owner/apPhcant hereby �grces to hold and save h.vm- <br />--------� -- less Ihe CAy ot EvereV from any end all claims lor damac�cs, co::ts, <br />expenses, or causec ol aclion ihal may arise because ol installati��n <br />and maintenance ol the improvemenl or olher riqht�o4way use nmclo <br />applieA tor and luriher agrees to remove same upon nohce Irom Ihe <br />���e City and to rr.place public property damaged thereby <br />FINAL INSPECTIOIv <br />Approved as Constructed <br />rw�relt PUBLIC WORKS DEPARTM[NT <br />� 3200 Cedar Slreet <br />F_vurett WA 98201 <br />Phone 259�Fi815 <br />Signatwe ol AppliCanl U�te <br />WORK AUTHO�IZED BY THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSU[D AND THEREAFTEP IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION THIS P[RMIT �v1AY BE <br />CANCELLEG BV THE CITV UPON ANY STOPPAGC OF WORK ON THIS <br />Pf70JfCT OVER 90 DAYS DURATION <br />