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I <br /> i <br /> I <br /> / I <br /> Date��•r0� TO POSTING 2i � ���:�w,,.�,PaC,�m�,c.� �B .�7i <br /> Applicetion For einn o�o� • t�G'�- <br /> PUBLIC WORKS PERMIT PJ�To�eFas`°°s <br /> Let.s ADo� im PuC 5 . <br /> Bennce Oun S��a'� <br /> Print or Type Only <br /> �.�t�.��r� -�(o ��, ��� i tl►�f-�-v � C� � ��.�r�� <br /> Ownar Mailing Atltlress City 2ip Ph��ne <br /> qpplieant Mniling Address Ciry Zip - Ph� /OC�JCJ I <br /> Desaibe P�oposed Work �� -- �� � <br /> _ -- W <br /> Pioiect Address(il knowi) ���0 � afln hnn n, �i!/- —. -- � <br /> Attach lour�41 copies ol plans lor proposed work- D�aw to scale and note ihe following as applicable: � <br /> • Property Liries • Cen�erGne ol sireel � <br /> • Outlina and dimensions ol ell ezis�ing and • Intlicate No�ih <br /> proposed slnidures on Ihe lut • Show any proposed gradin9 !hanqes <br /> • Exls�ing and proposed ulilities • Show measuremenls � <br /> � <br /> DO NOT WR!TE BELOW THIS LINE O <br /> Pt4M1T CONDITICNS <br /> 1.Aq call�::far inspectbn shell be rneda 24 hrs.in edvance�phono 259•8810. � <br /> 2.All v.�mY.shall be peAormed In eccordence with thls Permil and currenl Gty of Everett Desiqn ond Construction <br /> Sianr,�ar!s ard Specificetiona. <br /> . 3.Ca!�.oc:�tion Underground Servir.e 48 hre.before you dig TOLL FREE nUMBER�^800•424•5555. � <br /> /�2ri-t✓2�+J �or�., !ln.�.� -L� ,�(ere✓ C/1sr�L/fen+-�' O <br /> � o.c.c.� .Qa� �, <br /> � <br /> � <br /> � <br /> a <br /> acKNow�coc�nn�Nt or- coNnin� �s <br /> Th��unAar5�.7neA ownevaP����cant hereby a�iees lo hold and save hn�nr <br /> — ---- less the Gty o� [verelt hom any and ail daims lor tlama9es, cos!s <br /> �.Lp�j' / e.penses. or causes of ac�ion '.�al may nnee br.cause ol Inslallatio^ <br /> �s Q ' A / � OB and mainlenance ot the imp�ovement o� c��•E� �ighl-0l-wu'/ use here�.� <br /> ��,_. _ � �� � � applied lor an�4rth��r ag�ees to iercovu same upon notir.e Irom the <br /> �.pproved Construcf n Dale G�ty and to �afil�ce �c n�on damaged thereby <br /> C / <br /> � --� �� � ...��' <br /> �� �_ -, ,�. <br /> R!f1A� INS eCTl01 --��� Date ti/'�"� -y�'��--_ — <br /> Approvr.d as Co��istructed Si9Ma�Applicant Date <br /> WURK AU7h10R17[� BV THIS FEFMIT MUST BE 3TARTED WITHIN <br /> everrtl PU3LICWORKSOEPARTMENT 180 DAVS (lF DATE PERMIT I£ i851'�EO AND THEfiEAFTER IS TO . <br /> � 3200CederSlree� BE DILIGEKTI.Y PUFlSU[D TO GC!dPi.ETION. THIS PERMIT MAY BE <br /> Ereratt,WA9B201 CANCELLED OV THE CiTY UPON rN V STOPPAGE OF WORK CN THIS <br /> Phone�.259�8810 PFlOJECT OVER 90 DP.VS UUf:A7»N <br /> � <br /> i <br />