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��� <br />a � <br />�HN <br />��� <br />H �1 <br />��� <br />� <br />xR <br />� H d <br />��8 <br />�. � <br />�y� <br />g"y <br />C� t� V! <br />� � y <br />HO�n <br />�., <br />Date. �-�-3 -qt� <br />� <br />Applica�ion For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />v�-�-, 7✓ <br />Applicanl <br />Describe Pwposed Woin <br />�'�iy <br />Mailin9 AdAress <br />�9 /1�.�� <br />Mailing Address <br />� I Putll¢ Workf Pcrmil • � T <br />meu oeoi • �v,��y .. <br />� <br />r��nn� wo�.7 voa <br />roiai ran s <br />�esa<nni �eePa�� $ <br />Itaianru0un $ <br />�� <br />ZiP Phone <br />Proiect Address �d knov,ni - �n`/�-f JJ.GliY' ��( /� <br />Attach lour (4) copies oi plans for proposed work � Draw to scale and nole the loltowinc� as appliwble: <br />• Properry Lines • Centedine ol sircel <br />• Outline antl dimensions of all ezisting and • InAicate Norih <br />proposetl siructuros on ihe lot • Show any pioposetl gradmg changes <br />• Ezis�ing and proposr,d utiliues • Show measmemenls <br />PERMITCONDITIONS <br />1. All calls for inspectiun shall be mzde 24 hrs. in advance- phore 259•8810. <br />2. All work shall be pedormed in accordance with this permit and current City ol Everett Design and Construction <br />Standards and Specilications. <br />3. Call LocaUon Unde�gmund Service 48 his. belore you dig. TOLL FREE NUMBER 1•800•424•5555. <br />/ (/�. C!f[ri%y�- �'2smt-f �✓Of� IG�(�.�.,�I� <br />(� . <br />.C,a�s!� <br />fa"�CO��j, <br />/lJ z'Y -�O <br />Approved lor Conslrur,lion <br />FWALIWSrEC710N <br />Appravetl as Constructetl <br />evereet PUBLIC WOFKS DEPAR7MENT <br />� 3:00 Cedar Streel <br />Everelt, WA 98201 <br />Phone: 259�6810 <br />_ __. ___'._ __ _ _ <br />D;tle <br />Dalc <br />/G/2 3 <br />7 �,y�(,��W���/�1� <br />tr <br />' -�n <br />a Q r �'+ <br />� No � � ;�,� <br />� � <br />�L`' FG <br />� <br />antl savc harm� <br />lamages, cosls, <br />� ol inslalla�ion <br />way usc hereto <br />notice Irom Ihe <br />S Datc <br />V 4RTED WITHIN <br />1 EAFTER IS TO <br />0 ERMIT MAY BE <br />CADICELLhU BV IHh CIIY UPUN �MY SIOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DUFATION. <br />�■ <br />