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�"��c -�7� ��„�,.�.wa,r.v�.mn. �/dB^ �JI <br /> Date �,`- /�"��_ <br /> PhIU OePt �---.--r <br /> ApphcatronFoi ______ <br /> PUBLIC WORKS PERMIT R�necWnrwefre <br /> r����Fs� s <br /> lrse eno�«e Paie f <br /> Aeiener pun 3 2��O <br /> Print or Type Only <br /> � �/� �� I -+ T C' lll �� <br /> � 4 1 1��� � ` Mailin9 Add�,s �� Z��— ^ � hnne <br /> Owner <br /> ��.��-?`��3 <br /> qpphcent Malling AAAress C�ly Zip Phone <br /> Dascrlbe Proposed Work �` � <br /> ro23/- CA� -- w <br /> Prolect Address lil knownl � <br /> � <br /> Attach low(4)coples ol plons Ia propo^,ed work� Draw to scale and note the lollowing as apnhca6le. � <br /> • Propeity Lines • Crntedine nl stre�t <br /> • Ou��ine end dimensions 01 all ev�sting anA • InAicate Noilh <br /> proposed s�ruttures oa Ihe lot • Show any proposed 9iadin9 r,hanpes <br /> • Exi5ling end p�opo5ed utilities • Show measuremcn�s M <br /> W <br /> DO NOT WRI7E BELO�Y THIS LINE O <br /> PERMIT CONDITIONS � <br /> 1,All cells lor Inspecllon ehall be mede 24 hrs.in edvance�phone 259•BB1 O. <br /> 2,All worrt ehell be peAormed in eccordence with thls permil end current City ol Everel�Design and Construclion <br /> Stonda�ds and Specllications. � <br /> 3.Call Locetion Underground Service 4B hrs.belore you dig.TOLL FREE NUMBER 1•80�•424•5555. <br /> O <br /> � <br /> � <br /> O <br /> a <br /> �1CMNOWL[UGFMENT OF Ci)NDIIIONS <br /> lhr unA���siynr�d ownei/apphcanl liereby a9 °es to hNd ond save harm� <br /> — --------� less Ihe G�ty nl [verell I�om nny and ali ,;'a�n-.s for Aemeges, cn<t5. <br /> e.pensus. o� r.auses ol action ihal may ause becausc ol msinilation <br /> ��� p 3O And mainlenance of the imp�ovumenl or othr.r nphPobway use hereto <br /> // � �d,�or ,nd lurther eg�ee5 to remove snme upun noUce trom �'�r. <br /> Approved tor Constru tion Dat� v and`lo replace�mblic prupe'h� damaged thi�reUy <br /> ______--�e3?`�� 3�/3'J% I \\ \ � __—�_-�.� �—__ <br /> i <br /> FINAL INSPECT�ON Datc -- ' � " 1s-s--�-- (iate <br /> AnP�oved as Conslructed Siynat re I Appl�cant <br /> WORK AUTHORIZEO BY THIS PERMIT IdUST BE STARTEO WITHIN <br /> evrrett PUBLICWORKSDEPAPTMENT 1A0 DAYS OF DATF PEFNIT IS ISSU[D AND THERLAFTER IS TO <br /> � 9200CeCerSireel BE DILIG[NTLV PURSUEU TU COMPLf:TIqN 1r11S PERP.IIT MAV B[ <br /> Everett WA9B201 CANCELL[D BV TNE CITV UPON l�.NV S�OPPnGF OF N'ftt7n ON THiS <br /> Phone.259�8810 PROJECT OVER 9f1 DAVS DU�IATION <br />