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oace�l�{�! <br />npp�ication For <br />PUBLIC WORKS PERMIT <br />Prinl or Typ� Only <br />� <br />Applitant 4?aihnp Address <br />Describe Proposed Work _ <br />Ctly <br />�,,,�.��,,,-�,,,,�,�,�„�. �� �-�� _ <br />t��,,.� �,.,,� . _g1�z1513�`' <br />a,��,�,� v,,,,�, �.» s — -- <br />I��I.II (nP _ <br />l�'SM1AI�{�I (CY1�r��1 $. — <br />n.�:�n�,.o,�„ S 2C�— <br />�6 33`/-So/� <br />Zip Phone <br />7ip Phone -- <br />f Zq--'�ll��-L-�G� <br />Pro�ecl Addres5lil known) 3 � 15't-h �%t. ��� , <br />AU:ich fow 1�) copies ol plans lor proposed work � Draw to scalr nnd note the following es applicable�. <br />• Property Lines <br />• Outhne and dimensions ol all Ceistin9 and <br />proposed sVucWres on Ihe lot <br />• [�i5�ing :Ind proposed ulildies <br />• Centerhne ol streel <br />• Indicale Norlh <br />• Show any ProposeA gradm� chanq.�s <br />2 Show measuriunen�s <br />PERMIT CONDITIONS <br />1. All calls lor inspeclion shall be made 24 hrs. in advance � phone ZS9•BBi 0. <br />2 All work shall be pertormed in accordanca wilh Ihis Germil and wrrent City ol Even�B Design and Construction <br />Standards and Specilications. <br />J Call Wcalion UnAerground Service 4B hrs. before you dig. TOLL FREE NUM�Eq t• 00•424•5555. <br />4. Install rock constructio� ent.ranc� behind riveway as per city <br />standard M208 to reduce tracking mud onto streets and erosion <br />control as directed by Fublic Works Inspector. <br />5. Keep city streets clean at all times. <br />h. Curb, gutter and sidewalk in the plat are new and undamaged, <br />any damage thereto shall be r�alaced at the discretion of the <br />Public WurY.s lnspector. <br />7. Any chanqe in the driveway cut must be approved by the <br />Public Works Inspector. <br />O. Tightline all roof, yard and driveway drains from houses to sto <br />drain stubs at back of side walk with rubber gaskE�t P.V.C. pipe <br />9. Adju>t water boxes to grade at end of construction. <br />10. Driveways shall be completely cured before driving on thPm. <br />ACKNOWLEDGGMENI OF CONDITIONS <br />:� <br />�ii.tt-� � V��-T—t2lL ��c.�J'��� <br />?PP�oved lo� ConSVu � i Dale <br />l� i <br />�`� � L G��� � 'J�'- �� <br />FINAL INSPECTION Date <br />Approved as Conslructed <br />ev�v��lt PUBUC WORKS DcPARiMENT <br />� 3200 Cetlnr Street <br />[verell, WA 90201 <br />Plmne 259�OOtq <br />W <br />� <br />� <br />N <br />� <br />O <br />� <br />N <br />O <br />a <br />The unde�s�qned owner/applicant herol�� 39rces �o hold and save hmm <br />less the Gly ol Everelt Irom any antl ..�I clmms lo� dam:uior,. rnsV� <br />eapenses, or enuses ol ac�ion Ihal mny arise because ol intilall:�hon <br />and maint�nance ol Ihe improvoment nr olher nghFnbwiy usn h���rtn <br />apphed lor and lurther ngreas to remove samc uP���� ����ti��r� hom Ihr <br />Ci�y nnd to replace pubhc property damaged Ihmeby <br />d�l�-�-•-� 3����4� - <br />Si�nnlure ol Applica�it Dat�� <br />WORK AUTHORIZED BV THIS PERMIi MUST �E S�ARTED WIiHI^! <br />180 DAYS OF DATE P[RMIT IS ISSUEL` AND THENE4fTER IS TO <br />BE DILIGENTIV PURSUED TO COMf'I FTION TI115 PFRh11T 1�1AY �C <br />CANCELI ED BV T�1E CITY UPON ANV 1��1PP1'nGL Or WORr� flN TI u5 <br />PRU.Il�.CI UVf 1' �ill fIAV; DUfiAIION <br />