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, - <br /> � " 5 <br /> � � x <br /> H �y� �318_([�7 - �- 5-ZB-5 v�orc won.corm^u s��9� Z,��y��� <br /> MC C"� Oiaa Depl.� / ' <br /> y�tl Applicatjop For Z �]2�I <br /> �"° PUBLlC WOR;KS PERMlT °°°°°~'°M°�°° <br /> �/J H Total fee S <br /> � O� `� TO POSTIN6 ���` ��' �"ssRnoi FenPe�o $ — <br /> y ri c�^i O C] � r [- C� p [' �ainn�nova $�O J <br /> p p.� Print or Type Only z �� o 0 0 o r=� o ;r� +n r7 .. <br /> M �y O O r'.�i L� u 1 C. m �t O I<� <br /> L�70 (� . "" �ii �� r U i� � «iin. Ja �wili <br /> (�i w nC�' �\1` / /J //�� � H e� r w n h.l ��///II� �y �'� <br /> � ya _—��jl�l�� � I��/L/1 11��3 r=ll7�� �S/L1 n W/T � 7SO�� ,��"��_L� <br /> �`��d•,ner Ma0lndAiiqr�S�� �,' �� C�IY �� LP Pnone <br /> ri H 7.. Y C� iri n i r(-�� r� t� �� __. i� <br /> y O G 1— (l 3 (7 r G J J 41 J �� C: 'L <br /> g __C�7���-. - �, ._ ., �.� ._ <br /> p.� o a. =* =c ui �u ..• a oi a. � r.. rr, or+ <br /> � d� 4nPlicant Mailing AdAre55 City ZiP Phooe <br /> ��� /�Gu� .Sl�r7afQ ��Z C/• <br /> H O W Ucscriba Proposed Work . <br />��-: �: � � <br />� .�CP DS <br /> Project AtlCress(11 knownl � <br /> ' Attach lour 14)copies ol plans lor pwposed work- Draw to sca(e and note ihe following as applicable: � <br />' • Property Lines • Centerline of street /^ <br /> • Outline antl dimensions of all existing and • Indicate North V� <br /> proposed slmcWres on Ihe bl • Show any proposed gradin9 changes <br /> • Existing and propos�d utilities • Show measuremeMs �/� <br /> DO NOT WRIT[BELOW THIS LINE � <br /> �� PERMIT CONDITIONS O I <br /> . 7.All calls tor inspection shall be made 24 hrs.in advance-phone 259•8870. ^ ! <br /> �i 2,qll work shall be nertormed in accordance wilh this permit and current City oi Everett Design aid Construction ♦ , <br /> ' Standards and Specificalions. <br /> �=` 3.Call Location Underground Service 48 hrs.belore you dig.TOLL FREE NUMBER 1•800•42A•5555. � <br /> li <br /> � O <br /> I <br /> � �� � <br /> ,� � e_ <br /> 'fE- � <br /> � =1'_i � �p�n^�� , ,� s <br /> 1 �� / �n�� ��rL. O <br /> ,� ✓' ✓ ��� ; � G. <br /> ' !1� �1��`, ° � , �/ � ����i <br /> , 9G� <br /> , �vp � � qCKNOWLEDGEMENTOFCONDITIONS <br /> 0 QT�' <br /> I .� ,�`i The undersigned o�vncUapplicanl hereby agrees to hold and save hmm� <br /> I � ' � � ----` Ies: ihe City ol Everett from any and all claims lor damages, costs, <br /> � � <br /> � ezpenses, or causes ol action thal may arise because ol installation <br /> . ���n t ��,i/_,., � I _ q' and maintenance ot the impruvement or other right-of�way use herelo <br /> X I" l F'L�C J applied lor and furlher agrees to remove same upon notice from the <br /> Appruved lor Construction Dale City and lo replace public properry Camaged Ihereby. <br /> � <br /> PINAL INSPECTION Date —�w�-�L{-! ' /��"�" �'����/� <br /> Approved as ConSiruCted SignaWrc'ot AppliCant Oale <br /> � PUBLiCWORKSDEPAR7MENT WORK'AUTHORIZ[D BY THIS PERMIT MUST BE STARTED WITHIN <br /> 3200Cedar5lreet t80 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everett,WA 98207 8E DILIGENTLY PURSUED TO COMPLETION.TIiIS PERMI7 MAY BE <br /> Phone:259-BB10 CANCELLED BY THE CITY UPON ANY STOPPhGE O�WORK ON THIS <br /> FROJECT OVER 90 DAYS DURATION. <br />