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Datr___` 1_ �� 1 � <br />� �, <br />Applicahon I-or �� <br />PUB�IC WORKS PFERMIT <br />O <br />CJ <br />po OPJ Oo <br />C] p U CJ I�� fj <br />Print or Type Only �; �� �� o <br />o�� v�«, w r�i <br />+ Y' H w W <br />O N <br />�Ct t±� <br />Prabcant <br />Descnbe Proposed Wmk <br />Mailiny Ad <br />IdniLny Address <br />o ni%�I <br />o p � o <br />.+ w b7 C l <br />w w .( <br />y� _ _,n <br />�.���yU2 �j0p F OWR[��' <br />Ca1 � L a �l v Yt � Y�K N.~-� U <br />c�iv z�P <br />�.Lf.��iGl'�Q- !-{X. <br />Pro�ect AAdrres: Iif known) — 5-�� �� -�� ��''J <br />PutiL,: Worhf PnrmdA r'�_/" � c/—_ <br />e��q Dro� • _ -_. / /1 �[(J ��!— _ <br />� <br />Pu1nu.Wprwefre — ----' <br />Imal fnn s _ _ <br />lvef 4ppi fae Pnnf S <br />flalance Dua S �� � _ <br />Phone <br />,�,a;tt��� <br />Attnch lour IAI copies of plans lor pioPosed work � Draw to swle and note Ihe lollowmg a<_ ap�dicah�e: <br />• Properly Lines • Cenlerline ol sireel <br />• Outline and dimensions ol all eK�stinq anA • Indiwle North <br />proposed structures an Ihe lot • Show any proposed p�ndmq r.hanyes <br />• Exisling anA proposed ulilAies • Show measuremenis <br />L <br />PERMIT CONDITIONS <br />1. All call, for inspection shall be mado 24 his. m advanco � phone ZSJ•B8i O. <br />2 All work shall be pedormed in accordance with Ihis permil antl current City ol Ev�rct; Design and Construction <br />Standards and Specilications. <br />3. Cali �ocation UnUP�ground Sen•ice 48 his, belore you dig. TOLL FREE NUMBER 1•800•424•5555 <br />n. <br />5. <br />b. <br />7. <br />9. <br />9. <br />10. <br />Install rock construction entr:nce behi�d driveway as per city <br />standard q208 to reduce Lrackinq mud onto r�treets and erosion <br />control as directed by Fublic Works Inspector. <br />keep city streets �lean at all times. <br />Curb, gutter and sidewalk in the plat are new and undamaged, <br />�ny damage thereto shall b� replaced at the discretion of the <br />Fublic WorY.s Inspector. <br />Any change in the driveway cut must be approved by the <br />Fublic Warks Inspector. <br />Tightline all ro.�f, yard and driveway drains from houses to stor <br />drain stubs at bacA of side wa1V: with rubher gasket F.V.C. pipe. <br />Ad�ust water boxes to grade at end of constructior. <br />Drivewais shall be r_ompletely cured beiore driving an them. <br />rn'/N _ <br />�L — — <br />i� <br />—;'E�„ �VY'�` �. Z-Zs=�� <br />ApprOVCA lor ConS�fur,liOn Datr <br />��.1�/ '7-l4'-5/ <br />FINAL INS �CTION Dalr <br />Approved as Constructed <br />e���irlt PUBIIC WORKS D[PAfiTMENT <br />� 3200 Cedar Slreet <br />Everoil, WA 98201 <br />Phpnc 2Sy 9810 <br />W <br />� <br />_ I <br />i� <br />� <br />� <br />Y / <br />O <br />a <br />ACKNOWL[OGEMENT OF CONDITIONS <br />ihe undersi9nrd ownrtUnpPhcant heieUy agrres lu hold and s�ve harm� <br />less Ihe Cily ot [verett liom any �nd , II claims lor Aamages, costs. <br />rKV���SCs. or cau5e5 0l action Ihal may qnse beCauSe ol inStallahon <br />and mnintenance ol Ihe rtnp�ovement or olher nghPobway uae hereto <br />opphcd Inr anA lurther a9rces to �emrnr same upon nnhce Irom Ihe <br />Ciiy nnd lo re�plar.e publir, propeity dama9ed Ihereby. <br />,�� , > �I <br />7C�`'-�..�.. �� _ z � � 3 � s � �, � <br />Si9nature ol Apphcart Datr <br />WORK AUTHURIZED �V THIS PERMIT MUST dE STARTED WITHIN <br />180 DAVS OF DATC PLRMIT IS ISSU[D AND THEREAf7ER IS TO <br />�E DILIG[NTL1' PURSUED TO COMPLETION THIS PERMIT MAY BF <br />CANCLLLED BV THE CITY UPON ANY STOPPAGE OF WORK ON TH� <br />PFOJ[(,T OVCR 90 �AYS DUR.1710N. <br />