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� ..`, � <br /> a�o � Z(�� � u /� l' �j / <br /> ` \ ��iLl�f.1'!O'h5 Pwrm��� ��� L I� <br /> Applicat�n For ��-�o oec�.. _ <br /> PUBLIC WO�CS PERMIT ��,—�����W���s�Pe --- <br /> To�a�Gee S <br /> Q less 4pPl Frn Gg�� 5_ <br /> � ��o <br /> Print or Type Only = S � er�a��Po�� s_3� <br /> a <br /> '� � � � Oo2-31Z�o/ 7B3/ (����� <br /> � � <br /> I1�Ll�`� �^ ti � ��'ht��-��.�11P5���d ��'-�— <br /> Ownei V:, .. .� �• 7_�.;. Ph�nn <br /> � � � <br /> �d ~ <br /> ` � � ���_� =�1�--�S CL��i�%�--- <br /> APPhcant P:,.��.��;: a�idr�ss Cit�' ZiP ���— Phone � <br /> Descri e Pron�srA VJo k ��-'�hl�V��___ __ Y "�j____�]__,�-}qr����_.��_—._ <br /> � J <br /> �` n �-� - --��es�.--- <br /> --- - <br /> - ----- <br /> ��i z---- - - - - - W ��� <br /> L�� �L� <br /> ProledAddress(dknownl �`1� ___����J.�Q�. .(_UQ`���-_�_._____ � ,. <br /> �—. <br /> Af�Beh IOuf 14)COP�Cs ot Plnn& loi PrnPUsed k r�: - Diav: � i � . f��. .i',.i nc.le ihe ioq��� inq �5;fppl�eahl�• � <br /> • Pronerty Lines • Ccnl��rtine ot street � <br /> • Outline and dimensions ol all exist�ng and • Ir��,r.ale Nnrih <br /> proposetl structures on Ihe Int • Snow any r.ronosed gnh�nn cnnn;my <br /> • EHlsting and proposed utilities • Sh�.w mnasu�ements � <br /> DO NOT WRITE 6ELOW THiS LINE <br /> PERMIT COND�TIONS � <br /> 1.A�I calls for inspection shall be made 24 hrs.in adv:.nce-phone 259•$810. � <br /> 2.All work shall be pedormed in accordance with this permil and curren!City ol Everett Design and ConsVuction <br /> Standards and Specilications. <br /> 3.Call Location Underground Service 48 hrs.belore you dig.TOLL FREE NUMBER 1-800�424•5555. � <br /> `�: .L F %/�iS A2ri� �S To B� USFD AS /{ /�f�R�iNL� O <br /> l o T TN�'�c/ /��✓n7Ht",E' l�E�PM/T �,S R��C�//,C'�D. /�,Q,�iNlr <br /> �Df �7�L'Sf h'1�?ef C/ Tf/ STqhG'ql'C/S 7�vr PQ (//i7✓ J � <br /> C4i�o�Sf��in� �n�ll�rq/nASe Sf/Sf�i,� - /A <br /> � / �/♦ <br /> J �r.Tin�in� �roi� too{' c�oai��•SPov�S h�usf 6e pi,r�eG� O <br /> /q �0 7�e eX:S�in 4 C�c1c/7•ljat�•� un�/er�r^ouqC/. <br /> J <br /> �, {�-o✓i�¢ 2 2G /�f, t�io�e L����ds«Pe Sf.-i�o a�on,g S, Brna�va./ <br /> 4nc/ �t /!> fY• �•�ro�� LQh �SCti e Sf�-.y� alor,� l.�ZnJ�� The <br /> ��yi�ds��pin� S�al� c'nrisit �f !or✓n oi- nf/rev Lii,r �rou.,oLm��-i <br /> O :-av�c�eo�•c� S/�<<cc be qfto.%��/ <br /> L� S�i rc�f S ,,Cr frCCS. J n� ,9 ACKNOWLEDGCF.IENT OF CONDITIONS <br /> 'i,� �l !(Ji�S/n f�irCCJ/e�r,s', _ _ lh��undri�iqne4owneVapni�caniherebyagreestoholdandsaveharm� <br /> � � iess ;h�a City ol Everett Irom any and ali ,;;aims lor Aamages. cost; <br /> ��� � ; ey;�nses o� causes oi aclion that may anse because ol mstall2tien <br /> ' / � and rnaintenanr,e nf th2 improvemCnl or o�h2r righ!-ol�way u5e heieto <br /> �" ��;;pi�ed 1cr and fwiher aqrees to �amove same upon notice irnm the <br /> Ap ovetl I nst cti , i„ <br /> � � 'I f_ ty ar.�' to r lace pu6hc prone�ly da aged iherel y <br /> ' � � <br /> FINAL INSPECTION p�te I 1� ��� <br /> Approved as Constructed �s��5-�!� I ,oi v -'o�qnn�ican;_ Datc. <br /> /Arla� PUBLIC WORKSDEPARTMENT l4'OP, . AUTHORIZED BY T! IS PERMIT MUST BE STARTED WITHIN <br /> 3200CedarStreet 18f1 DAVS OF DATE PERMIT IS ISSUEU AND THEREAFTER IS TU <br /> Everett,WA 98201 BE DILIGEN iLV PURSUED TO C01.1PLETION. THIS PERMG UAY BE <br /> Phone:259�8810 CANCELLE� BY THE CITY UPON ANY STOPPAGE OF WORK ON 7HIS <br /> PRQIEGT OV[R 90 DAYS DURATION <br />