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�x-? n[� H <br /> tl1 C�7 � • <br /> D � x <br /> H 'Z � �l� ��ni��cwo�x.^�'"'�-��—/ y� ` <br /> Date <br /> Gina Deb. _�� <br /> K y ^� qpplicat�nn Fni <br /> � yH PUBLIC WORK�a PERMIT `°`,'",•'°".`"° S --- - <br /> to�.ir.� <br /> � � Iese>nn� fe.Pn�e S <br /> � b e��r,,.�e�. S ��— _— <br /> � ��y Print or Type Only <br /> O <br /> Q• O ' <br /> H �y� -�,,�,�-{�''� j� � � r�� �X 1� i3ri�. 98D� <br /> yH TY-{��U ��[S�L� � �"� I � ��y Z p Pnonc <br /> r H� ��y�Q1 Idadmg Atldress <br /> `� L-�-g 1- � �J� <br /> N <br /> C] t7 V� — <br /> �'i tdailing Atldress Cdy Zip Phone <br /> �s� t+ ApPlicant <br /> [�J <br /> y o� f�f��� ( �-f- 3 <br /> Describe Proposed Work .�1L—J <br /> W <br /> Pmlect Address I�I knownl <br /> .�-S'"5 — i�.E l-/� 7r� ���� � <br /> Attach lour(4)cop�es o�Plans lor proposed work� Draw to scale antl note ihe lo�lowio9 as applicab!e. — <br /> • Proper�Y L�nes • Centerline ol street `w� <br /> • Outline and dimensions of a�l exisimg antl • Indiwte Norih � <br /> prOposed S��uctures On Ihe lol • Show any pwposed yratl�nq chanqe, <br /> • Ez�st�ng and proposnd ulihties • Show measuremenis � <br /> %-� DO NOT WRITE BELOW THIS LINE O <br /> I C�� PERIdITCONDITIONS � <br /> 1.All calls tor inspeclion shall be made 24 hrs.in advance-phone 259•Sd10. <br /> 1 � 2 All work shall be pedormed in accordance with ihis permit and current City ol Everett Design and Cor�c'mction <br /> � StandarOs and Specifications. � <br /> � �=' 3.Call Location Underground Service 48 hrs.betore you dig.TOLL FHEE NUMBER 1•SOO•424•5555. <br /> ! , / /c �"'i` �l .!��7C.� .�GI' �i ��-c-7` ,r�CF.GC; ��l��i_- O <br /> I � �`L n,i ��!�G,o�.% .-C�4.2c'nti >�7` -s!,� .j��zt'7. �1� � <br /> � � - <br /> .S�,c�� �c-,�v /�.��c-�v]fr', �, //\ <br /> \/♦ <br /> �� O/� <br /> li <br /> � �_�� <br /> � ACKNOWLEDGLMENT OP COIJDITIONS <br /> The unde�signed ownedapplicant heieUV�5�ees to hold and save harm� <br /> ��� less Ihe CAy of Evere111rom any and 311 daims tor damages. cosls. <br /> ) � / e•penses. or causes ol action Ihal may arise '�ecause of installation <br /> �" ,(/ /', �J[��, /l� /�z/8,� and amlenance ol ihe improvement or other right�ol-way use hereto <br /> J� /f 7�I U ap lie lor and Iwlher agrees to rr.muoe same upon notice Irom ihe <br /> An � �� �o�_, _,_ Date Ci �an 1 b renlace public property damaged thereby. <br /> �.' _ ' —=.=..i-. <br /> �\' — _ y-- _- +r��S� dl`� �' _.�/ _ _ _ <br /> FlNAL la -C ON ' Date � , ' � D te <br /> Approved aC O� !�uded i�ni�,l te �APPIiCant <br /> \ � WO K A ORIZED BV THIS PERMIT MUST BE STARTED WITHIN <br /> 0 evrrctt PU ICWORKSDEPARTMENT 180 S DATE PEFMIT IS ISSUED AND THEREAFTER IS TO <br /> 3200GedarStree� BE DIL ENiLY PUFiSUED TO COMPLETION. 1NIS PERMIT MAY BF <br /> Evereft.WA 99201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON 1 Hi5 <br /> Phone:259�8810 PROJECT OVER 90 DAYS DURATION. <br />