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��.a1 <br />��F� <br />Fn <br />`C � <br />��� <br />� <br />x <br />o�d <br />Q�8 <br />yH <br />C+�� <br />Q M <br />��N <br />O� <br />,� v <br />� �� <br />� -�- <br />� __, <br />j "r <br />�a • �� <br />�.� i�� . <br />Da'e 2�4/91 _ , . <br />ApplicatlonPor % I � �� <br />PUBLIC `WORKS PERM IT ;-;; :. ,.-'— ' - <br />1 <br />Print or Type Only <br />TO POSTIN6 '�-�� 9z <br />�,,,,� � w�,,., N�,m, .1/�3/ <br />� <br />�,,,,a �„�, . 91/26387 _ <br />����,�wo,.,F�a ---- <br />iolni�ee S <br />�eee �oo� �.e vaie 5 �— <br />Oapnce Dun � � �� � <br />�llen Weddle 6424 Beverly Blvd. Everett 98203 353-1372 i <br />Owner Mailing AtlAress City Zip Phone <br />Owner — <br />--APplitant----� � MailingAddress Cny Zip Phone <br />Uescribe Propc��A Work <br />Projecl Addrecs lil hnownl <br />AUach four �4) copies ol plans lor proposed work � Draw �n sca�e antl �nte the followin9 as applicable�. <br />• P�operty Lines • Cen�e.dine ol slreel <br />• putline and dimensions ol all exislmc� and • Indicala horth <br />proposed s�ructures on Ihe lo! • Sno�.v any proposetl 9radmp changes <br />• E�isting and proi�osed utilities • Show �nedsurements <br />�'='=` �- <br />PFRMIT CONDITIONS <br />� �111 calls lor inspection sha!I 6e made 24 hrs, In advanae - phone 259•$810. <br />�. All work shall be pertormetl �� accordance witli this permit and curreni Ciry C� Fverett Oesign and Consiru��liun <br />Standards and Snecilications. <br />:i. Call Location Undergrodnd Servicn 48 hrs �elorr yw d�9 TOLL FREE NUMBER 1•800•424•5555. <br />� � �l�2.yy�_ ����'/� <br />l.pp'ove ! Iw orstruytion Date <br />� / <br />"`y <<, � � - -----�= J- i' z -- <br />FlPblt.�.t� �( F TK�N -- �-_—_ Oatc <br />AGoruvetl ,.. �, n:'n¢teA <br />i•�.i.�p(` PUBLIJWORKSDBPARTIdENT <br />�� 32(�O Cedar Strcel <br />Evarel6 WA 98201 <br />Phonc 75T00�0 <br />W <br />� <br />�w <br />� I <br />Z <br />O <br />H <br />� <br />O <br />a <br />ACKNOWLEDG[MENT OF CONDITIONS <br />1 hc undcrs�qnutl owner/apphcanl heretiy agrees lo hold and save harnr <br />lusti Ihe Gty nl Evereil �rom any and �II claim5 lor damaqes, cosi; <br />expenses. nr causes of ;icUon Ihel may anse hecause ol inslallation <br />❑nd mnin�mance ol the improvemem or olher n9h4ol�way us�� hcreto <br />applurd for and lurlher a9roe5 �o iemove Same u�nn nolice Irom O�e <br />Ci1y and lo replace pubhc propmly damayed Ihereby. <br />�J [ / /i/ / <br />�"!� � :rfil.L:t:L� ` f { . � _ .ii� I � L'-: _. <br />S�yns�mc of Apphcant Date <br />WOR4; AUTHORIZED BV 7HI5 PEhM1T MUSi BE STARTED YIIiNIN <br />tA0 DAYS OF DATE PERh11T IS ISSUED ANO THEREAFTER IS TO <br />BE DILIGGNTIV PURSUED TO COMPLETION. 7hIIS PERMIT tAA'I B[ <br />CF�JC[LLfD BV TN[ CITY 11PON ANV STOPPAGE OF N'ORK O� THIS <br />PRCJF CT OVEH �O DAVS DURATION <br />(�. .x�r�:,.� <br />