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�� H .- <br /> c�H �� Pubhc Wmh�Permil• 9�-D�n <br /> � y �' Dale 2 2 Z . <br /> y �� � / ema een�• — <br /> Application For <br /> oxo <br /> PUBLIC V�/ORKS PERMIT °°°1w;Feefeo g <br /> �1 M �1 less Rpol Fee PeiC $ <br /> ��� Print or TyPe Ony To Posr�rac � � Ba�•��a��, S �,o �"A.��.�=-. <br /> ON �y <br /> �t�+y O � `��?� 3/D�: - ncr � 5��O� 2Sc'..3/G B <br /> p„ � ��; �,ly Ll�.cmy �N'.� t [�i'zc� y� <br /> zy M � OK,��� Madmg Addres5 U City Zip Phone <br /> rty N H ,�•L,� i✓ �G'u�G 710 i��LP��.f SY JS�Mr...F'a.�.� 9i9o.�3 d'�'B-1/5�( <br /> p �y �'+PPliwnl Mar�ing naaress CitY Z p �j`i P-/.���7c �'n/� <br /> �Ci] H � �/ <br /> CI�Y� �4 n <br /> [�7 Describe Pr`o�poseC Workn � � <br /> H O yi .0 /`�U�J�-cc �1-��1� Q�� R cx-c/�u� ��'.�GZac' <br /> W <br /> Proiect Addresslil knowN 3/O� " �r02d�a�/ � <br /> Atlach four(4�copies ol plans�or proposed work•Draw lo scale and note the�ollowing as applica6ie: �� <br /> • Froperty Lines • Centedine ot ctreet � <br /> • Outline and dimensions ol all existing and • Indir.ate North <br /> proposed slruclures on Ihe lot • Show any proposed gruJing chan9es <br /> • E*�sting and pwposed utilities • Sho�v measurements M <br /> W <br /> DO NOT WRITE BELOW THIS LINE O <br /> (��' �--'�� PERMIT CONDITIONS � <br /> 1.All calls lor inspection shall be made 24 hrs •,n advance-phone 259•8810. <br /> � C'. 2.All work shall be pedormed in accordance wilh Ihis permit wnd current City ol E:erelt Deslgn and Conslrucl�on <br /> i i Standardsand�pecifications. <br /> 1 � 3.Call I.owlion Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1-800•424•5555. q <br /> � t/ �/ / // / O <br /> �w.�� T, el"�.�lCe� C��50 .Cc�c2 �nked'.y �`o �Cc.lc �i�;� /i� �- c'�����✓ <br /> ; c?2 :2�CG����/ �l /:c.'�7.�' e�tct`,G��I�z`�td— 2�.c�✓ v���i/ <br /> � � ��,�/�� �,..��� �:��a�� E— <br /> ri /k�.:.ai �j�, lTZt�>U:v "" "'- �l'lnOZ�y <br /> � �` � � <br /> �.f�. /�'a'�.�.� a-� .�.c:, .�,�,�� Q.�. od��,:�c�d' 6y <br /> ' �_ ,� ��y � � <br /> �._ �. <br /> � - <br /> i �' ' � ACKNOWL[UGLAtENT OF CONDITIONS <br /> � The undcrsigned ownedapP�icant hereby agrees lo holtl and save harm• <br /> ' less ihe Cily ol Eve�etl Irom any and all claims for damages. costs, <br /> I ` — expensr.s, or causes ol action that may arise because of inslallation <br /> � �,—, � _ `�Z _ and maintenance ol the impiovement or other righbobway use hereto <br /> \ iG. . � applied for and lurther agrees lo remove same upon nolice Irom the <br /> ApP�ooedl r� r ctlon � ��« City and to�eplace public properry damaged Ihereby. <br /> % � � � <br /> , c�_�7 � <br /> FINAL INSPECTION Dale ��� '� � � �'�� � � ��� ''�� Cr�r+S�' <br /> AaP�o�cA as Cunstructed <br /> Signalu e ol Applicant Dale <br /> WORK AUTIiORIZED BY THIS PEFMIT MUST BE STARTED WITHIN <br /> evcretl PUBLICIVORKSDEPARTMENT 1g0 DAYS OF DAiE PERMIT IS ISSUED ACJ THERFAFTEf7 IS TO <br /> � 3200CedarStreet BE DILIGENTLV PURSUED TU COMPLETIOK. THIS PERMIT MAV BL <br /> Everetl,WA 98201 CANCELLED BY TNE CITY UPON ANY STOPPAGE OF WORK ON THiS <br /> P:�one:25��8810 PROJECT OVER 90 DAYS DURATION. <br />