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=� Ci H �-.. , <br /> �1 Ia�]��1 '�. <br /> 10 �1 'ayC �/� <br /> C" �y De1C'_cJ.�� 1 n�n���wo,�a v 7�Q}" '^�� � � . <br /> HZ � n�na o�ni . ��I?f..�_I_��_'"_"�" . <br /> � � Atlplif,ahc- Fur <br /> H 77 i�ibucwm�eiee ------'__ _�'_ <br /> � � � PU�LIG WORKS PERMI�' .o,.���e s_ _ <br /> � H '.��ss.bo�.Fne Pam �— — <br /> z Print cr Type Only � � ��� $ �� o� <br /> �O� — <br /> H <br /> OH <br /> O �� �� <br /> �`� n �1�1` +�'x�c ��" �c�.�—� �^6JI �lP� �-f�UJlo <br /> x y� Owner Mailing Adores� City Lp Phone <br /> � �..i y 1 l3 /—��j� <br /> GN <br /> U �W Apphcant Id�Jing Address Ciiy ZiD PhonC � � � <br /> ��[�+ � -�/� L �. <br /> y� Describc Proposed 1Ynrk .� �{=1�—_ . -- <br /> HO�n <br /> W <br /> Pro�ect Adtlress(d knownl J���— /7�(l i-LJ:< -•'��/ � <br /> Attach lour 1�)copies ol plans lor proposed work� Draw io scale anA note Ihe tollowing as applicable: � <br /> • ProperlY ���es • Centedinr. of slreel ♦^ <br />� • Outline and dimensions ol all ezisting and • Indica�e North V� <br /> proPosed 5�ruciure5 on ihe IOt • Show any proposed gradmg chanqes <br /> • Ea�sting and proposed u�ililies • Show mcasuremenis /�/� <br /> W <br /> DO NOi WRITE BELOW THIS LINE O <br /> FERIdIT C6NDff iUNS <br /> ���` 1.All calls lor inspection shall be made 24 hrs.in advance-phone 259•881 Q � <br /> 2.All work shall be pedormed in accordance wilh this permit and current Cily ol[vereV Des�yn and Conslruction <br />� . � Standards and Specilications. <br /> 3.Call Location Underground Service 48 hrs.be�ore you dig.TOLL FREE NUMBER 1•800•424•5555. � <br /> '�� <br /> 1 '. O <br />� ' i�� ��/wJ <br />� _I <br /> II i O <br />'� � �� � <br /> I ' 1`' ACKNOWLEDG[M[NT OF CONDITIONS <br /> � The undersigned owner/applicant hereUy agrees to hold and save haim� <br /> � less the City ol Everetl Irom any and all olaims lor damages. cosis. <br /> / expenses, or causes ol action that may aiise because ol mstallation <br /> �'�� ' �i and n �inlenance ot Ihe improvement or otner righ4ol-way use hcre�o <br /> ,��f�'/���'��'�?� �7 � �� applre lor and hnfher agrees to remove same upon notice imm ihe <br /> - Approved lor Construc � n � Date Cdy �i to.re�lace publlc pmperty damaged ihereby. <br /> 0 <br /> ' � �o-r- �j��- _ _ -= - <br /> FIIJAL INSPECTION Date ' " .,�" - -' <br /> Approved as Consiruc�ed $� itwe �f�pphcant Da�e <br /> cvrrrit PUBLICWORKSOEPARTMENT �'�� < AU`y10RIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> O 320GCedarStreet 180 AYSY�F DATE P[RMIT IS ISSUED ANO THEREAFTER IS TU <br /> Everet4 WA 9A201 DE DILIG[NiLY PUFiSUED TO COMPLETION. THIS PERMIT MAY BE <br /> CANCEI.LED BY TNE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone:259�8810 pROJEGT OVER 90 OAYS DURATION. <br />