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crEnvr <br /> a - <br /> APPLICATION/UTILITY PERMIT zaut <br /> ENGINEERING/PUBLIC SERVICES 3200 CEDAR ST, EVERETT, WA 98201 <br /> FEE DATE S 1 Cl 1 201 <br /> SERVICE ADDRESS '\y\5 Al R9O12T Rc3 <br /> PERMIT NUMBER: GTE PUD PSE <br /> TCI AT&T OTHER <br /> UTILITY ID NUMBER{ <br /> OWNER `' OYOrr tiSh �y i <br /> ADDRESS CO93ACALA.Fotn(G F <br /> CITY E-0 eA- 4 ZIP q%a1)1 <br /> UTILITY CON CT CCtS�t UvS2r PHONE 14,DS "($� sa r6 <br /> SIGNATUREQ�1yi-,,� C �. kn an <br /> CALL 257-8810 IMMEDIATELY PRIOR TO STARTING WORK! <br /> JOB DESCRIPTION: TWO(2) COPIES OF THE PLANS AS AMENDED, SIGNED, AND APPROVED <br /> THE APPLICANT/CONTRACTOR HEREBY AGREES TO HOLD AND SAVE HARMLESS THE CITY OF EVERETT FOR ANY AND ALL CLAIMS FOR DAMAGES,COSTS, <br /> EXPENSES,OR CAUSES OF ACTION THAT MAY ARISE BECAUSE OF INSTALLATION AND MAINTENANCE OF THE IMPROVEMENT OR OTHER RIGHT-OF-WAY USE, <br /> HERETO APPLIED FOR AND FURTHER AGREES TO REMOVE SAME UPON NOTICE FROM THE CITY AND TO REPLACE PUBLIC PROPERTY DAMAGED THEREBY. <br /> PERMISSION IS HEREBY GIVEN TO DO THE WORK ACCORDING TO THE APPROVED PLANS AND SPECIFICATIONS. STREET CROSSING WILL BE MADE BY BORING. <br /> TRENCHING WILL BE PER CURRENT CITY ORDINANCES AND DESIGN&CONSTRUCTION STANDARDS. <br /> APPLICANT COMMENTS: <br /> REPLPCJt1.X, PLi3 'TQi1/41VSFo2mez. W1 u. rbloc.1c_ one. ® l_A- (14.0n1.14wr-511. <br /> dor cUpprox. 2 1,-\ools. <br /> DO NOT WRITE BELOW LINE DO NOT WRITE BELOW LINE <br /> CITY COMMENTS: /4 3 <br /> INITIAL INSPECTION DATE 47/4 SIGNATURE <br /> PERMIT ISSUED DATE 8 - 043-/1 SIGNATURE _ <br /> CONSTRUCTION APPROVED DATE SIGNATURE <br /> CALL 257-8810 IMMEDIATELY PRIOR TO STARTING WORK! <br /> WHITE COPY-CITY PINK COPY-APPLICANT HARD COPY-APPLICANT(FIELD COPY) ly <br />