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Date Z 3 �j I " <br />�� �nn��c❑non Fo� <br />[�U�LIC WOR4C$ <br />0 <br />S <br />����� � <br />Print or Type Only� <br />� 03Pu� o 0 <br />� « M N M p <br />cy� 4�yp U � <br />a� s i m <br />Describe Proposcd Work <br />PEREIAIT <br />o�� <br />M � tn <br />N ti <br />� � F <br />5,.5� � Cl�y <br />��� <br />, c� <br />`55 Qly <br />Proiect Address Id knownl _�� 7 J E-h ;L, ���/ <br />i'i.S�,r:lYnnaPermpil• ���� �� <br />ti��i,i n�ni . —1��-�-4a�L� <br />, „�,� ,��, � �,.----- - <br />r��.,���,. a-- <br />��.,, �„�,� ��� �w,,, s <br />�., .,,,, � ���, s � � — <br />4 <br />_ _ % i+1 <br />L , Phone ` <br />� <br />�.,.� • / . � _ / �� � / .. <br />Atlach lour �A) copies ol plans lor proposetl work � Oraw lo Sc�le and note �he lollow�ng as apPlir,;,l�li• <br />• Properly Lines • Centerline al stre.el <br />• Oulllm� :vnd dimensions of all exishng anA • InAic:f�e Nor�h <br />proposed struclures on the loi • Show iny proposed giadmq rhnnqes <br />• Existinc� and proposed utdihes • Show measurmnrnts <br />��.��:ur� <br />PERMIT CONDITIONS <br />1. All calls lor inspection sha!I be made 24 his. m advance - pLo�e 259•8810. <br />2. All work shall be pedermed in accordance with Ihis peimit ani current City ol Everelt Design and Constructior� <br />Standards and Specilications. <br />3. Call Location Undergiound Servlc= 4B hrs. belore you dig. TOLL FRE= NUMBER 1•800-42�1•5555. <br />r� <br />� <br />� <br />Install rock construction entrance behi.nd drive�.�ey as per city O <br />stanciard k208 to reduce tracking mud cnto street:� and erosian <br />control as directed by Fublic Works Inspec!•�r. <br />Keep city streets clean at all times. L <br />Curb, gutter and sidewalk in the pl�_ are new and undamaged, r <br />any damage thereto shall be replaced :at the discretion of the � <br />Public Works Inepector. <br />Any change in the driveway cut must bia approved by the O <br />Fublic Works InsNector. <br />Tiqhtline all roof, yard and driveway drains from houses to stor a <br />drain stubs at back of side walk r�ith ru6ber qasket P.V.C;. pipe. <br />Arfjust water boxes to grade at end of construction. <br />Driveways shall be rompletely cured before driviny on then�. <br />ACKNOWL[DGLMENT Of CONDITIJNS <br />The undcrsigned owner/appl�r.anl hen�by agrees to holr, and save h.,rm� <br />-- less Ihe City ul EvmMl Irom any and all claims Lr efama9es, cosis. <br />�� r.penses. or causes o! ar.tion Ihat mny anse bec �i •�o ol instnllahon <br />� . c_ � � �_ �� and mainleninCe ol the improvemen� or olher righl� �bway use hriclo <br />�(�=� ��� �X"' L' L,� ,� apPhed loi and lurther a9iees lo remove same upon � ntir.e'�om Ihr <br />ApP���ed for Con��t�} . // Dale. Cdy and lo rrplace public pioperly damac�eA Iherr,by <br />n Y <br />.' \�_[���t�J ��� ''� �i <br />FINAL INSPECTION � Dale <br />ApP�oved as Gunslructed <br />rvrn•tl PUHLICWORKSDE.^�RTMENT <br />� 3200 CeAar :itreet <br />[ver��tt. V..i i.9101 <br />Phonp .:.rqH10 <br />�� -C�.�`—.�..e...� 3�/3�9�L_._ <br />Signatwr ol Applicant D.dr <br />WORK AUTHORIZFD �V THIS FERMIT MUST BE STARTED WITHIP: <br />1�0 DAYS OF OATE PERMIT IS ISSUED AND TH[FEAFTER IS TC� <br />�C DILIG[NTLY PURSUED TO COMPLE710N. THIS FFRMIT MAV �L <br />CANC� LLf D �V TNE CITY UFON ANV STOPPAGG OF WOflK ON iHIF <br />PROJFC7 OVf R 90 DAYS OURAIION <br />