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� <br /> � � � = -r- 3oz�-s ��bz <br /> Cy � N r�„ei��:wo��.r.�m/�n. � �`Q <br /> !• � Date� TO POSTIN(� ( ��I k � !¢ oinu oeo� •_{-/��+ '---�--- <br /> 1�1 Aap�� <br /> � � � PUBLIC WORKS PER�IT P����I¢WarFafee s_ _ <br /> Tnlai Fne <br /> � � ie�seoo��ee PeN S—�,�—,...� — <br /> � g g�ri �i � � .i,�`�� S S � <br /> Q �1 P�int or Type Only � � � o� M � ���///JJJ � �� °� <br /> F Ea r� m.. n <br /> N MN Nh M � � « N .�-� <br /> N �"� r M <br /> y O � n �`b olSr'1 -`Iz-0 <br /> � � �pc � � Phone <br /> M O er Mailing Atld ss S �3 CA Y ��I a; <br /> � �y r�d- �3i3��� ro � Gl � �S .~i .. <br /> � N � <br /> !� � e Zi Phor�e '. <br /> p� qpp�icent Matlin9 Address �'�Y P <br /> �!1 <br /> Describe PmPosed Work <br /> W <br /> Prolec�Address�il known� <br /> ID25 a.Ncat_� t�A*l� — � <br /> � <br /> Allach lour(4)copies ol p�ans lor?�oposed werk-Draw to scale and nole the lollowmg as applicable: � <br /> • Property Lines • Cenledme ol slroet <br /> • Indicato Nor�h <br /> • Ou�line and dimensio�s of all eaisting and � Show any propnsed giadiny changea <br /> proposed sl�uctures on Iha lol � Show measuremenls M <br /> ""'�� • Eeisling and prOposed utilities W <br /> rC�! DO NOT WRITE BELOW THIS LINE O <br /> � J ,� PERMITCONDITIONS � <br /> 1 1,All cells lor Inspecl�,.n shall 6e made 24 his.In edvance-p�one 259•8810. <br /> � 1_� 2.All work shell 6e pedormod in ar.cordance wl�h thin perml�end current City ul Everott Design end Conslruction <br /> 'f��I Standerde and Speclfications. � <br /> � , 3.Cell Locatlon Underground Service 4B hrs.before you dig.TOLL FREE NUMBEH 7•800•424•5555. <br /> �� Q. J�iZ.�VE��+f Loe�-rio�.t stwwti) a�� t�lcsT M�.'Rei 'Ex.is1'tNCo O <br /> I '��� �p2��w�.�l �oc.a..T�ou i N 'T� �ieu'�, a�P�� cAM�.�T �bbkLl. <br /> �.l.�e �X�sn►JG Prt����v�►+; �� �vRat � <br /> 6PF✓�,v-�_ (z,fS?'�O�lrc E S� � � tD, GtAl�1�') � <br /> ��� <br /> �� wt� H�le.riT �v2� � CavTf�(Z- £, 5�D��vM..� t"�2 S <br /> �p5 � 3oCn . 'N�v 1�n.vE .v/�-t -+o $F�-O�s�'f�'I�eYJ ks O <br /> � y�0(t. [�'M s-fD ��n1 '�30-7. — w� pR� ,(E.v,�t W i �n+ � <br /> �� . <br /> ` �� <br /> i . <br /> I '_'_' ACKNOWLEDGEMENT OF CONDITIONS <br /> jTha undcisi9n�d owner/opplicanl heru6y a9rees lo hold and savo herm� <br /> � less Ihe City of Everelt ��om any and all cleims lor AameBes, co�ts. <br /> rt rxpen5e5. o� causes ol aclion ihat rnay arise because ol inslallation <br /> /'� and maiNenanco ol the improvoment or othor right�ol-way use horeto <br /> ..l� 4 �a'�e.�� Z��,^ 9� appliod br and Wrlhm a9raes to romove same upon notice I�om Ihe <br /> Approved lor CooStJuction Dale City nnd lo�replace p/ubl�c pyr pefty-daq�agod�hereby. <br /> � /. <br /> 4= �� yr�'— ._ <br /> i�y.; �-' /C�/G - �i� lL/ �l�!_� <br /> FINAL INSPECTION ��1e , Date <br /> Signature o�APpllcant <br /> Approvad as Conslrutted WORK AU7HORIZkD BY THIS PERMIT MUST BE STAFTED WIIHIN <br /> � evcrett PUBLICWORKSDEPARTMENT 180 OAYS OF DA7F PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � 0 3200 Csder Stioet BE DILIGENiLY PURSUED TO COMPLETION.TNIS PERMIT MAY BE <br /> Everett.WA 98201 CANCELLED BV THE CITY UPON ANY STOFPAGE Of N'ORK ON THIS <br /> Phone:259�8810 PROJECT OVER 90 DAYS �URATION. <br />