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1 <br /> �� � <br /> I <br /> C �� <br /> yZ� Date�C.�—� f��1 �II� v�ei,�wo,w.re�mn� <br /> 1< O � tliec �•n� � ��- <br /> ��y qppliwtion For <br /> �� PUBLIC WORK� PERMIT �°"°""°,"�". _ <br /> mi.i r.. <br /> �� ��e.euw r..v.m S <br /> o.i.,��on��. S <br /> O�� Frint or Type Only <br /> ��g <br /> ��" d.l � Q (rsc�_ �'o�� (�—�c� c.v� �'�a�� <br /> A H�, — �`y�ef�� Mndmg Adiress City Zip Phone �—� <br /> �� <br /> �y�y Z /�/.� /1 �� ��7�)/J / I�. �v �P�� <br /> O y M C iJ �CJILV�,_�i' L �1�—��1 c4.� � <br /> n�y���+++ APP���p�� Mailinp Address 4 ���Y �N Phone <br /> �O� Describn Proposed Work ��� �` ��� <br /> — — W <br /> Proiect Address(il known) ��L/ � <br /> � <br /> Attech lour 14)coplas ol O�ens lor proposed work� Draw lo scalo and note I�e lollowiny as applicnble�. � <br /> • P�operly Lines • Genterline ol streel <br /> • Outlinc end Aimensions o�ell e�isting antl • Indicate North <br /> proposed SVur.�ure5 0�Ihe lot • Show any proposed g�ntling changes <br /> • E��stinB xnd proposed utilities • Show measurements � <br /> / , _ DO NOT WPIfE BELOW THIS LINE O <br /> � \ <br /> C�I f'ERMIT CONDITIONS � <br /> 1.All calls lor inepection ahell be made 24 hra.In edvanc��phone 259•8810. <br /> ' � I 2.All work flhell 6e pedormed in eccordance wilh this permit and currenl City ul Everett Duslgn end Consiruction <br /> � Standerda end Specilicatlons. <br /> �+'� 3.Call Locnllon Underground Service 48 hra.belore you dly.TOLL FREE NUMBER 7-800•424•5555. � <br /> O <br /> � �lr.n(:Pl� t ':l:, �J.� i,i. � �`/ 'r . t� s:�iii� �� <br /> f �/� <br /> I ��� ,��; <br /> ` �� r� V♦ <br /> 1 Q <br /> ��1 <br /> ; ,- <br /> a <br /> __ <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> � Tho unAer5�9neA owneqnpplicaM hc�ehy agrees te holA and save harm� <br /> �_ --- Irss thn Ctly ol Everetl Irom any and all clalms lor d�mnges, r.osts. <br /> �' a�pensus or causes ol aclion thal may anse Uecnuse ol instnllnhon <br /> anA mninlenance ol Ihe improvemenl or olher righPol�wFly usr hrmto <br /> appliaA for nnd lurlher agreCS lo remove 5ame upon nolice Iwm �hr <br /> Approved lor Conslruction ���� Cily anA lo replar,e pubhr,property dameged Iherehy. <br /> 1"INAL IN;PECTION ���� — ONe <br /> Approved as Conslrucled Siqnature ol 4nn��r.an1 <br /> WORK RUTIIOHIZED �Y THIS PEFMIT MUSi BE 5?ARTED WITHIN <br /> � PUBLICWCRNSDEPAR7MENT 1g0 DAV6 OF DATE PER�dIT IS ISSUEO AND TNEREAFTEP IS i0 <br /> 3700CMar5lmet BE Dll�.tiENiLY PURSUED TO COMPLfTION THIS PEPMI7 MAV BG <br /> Evcre�l.WA 90201 (;ANCELL[D BV iHE CI�I UPON ANY STOPPAGE OF WORK ON THIS <br /> Pnone :57 BA10 PROJECT OV[H 90 DAVS OURAT�:Y <br />