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� � <br /> "°"��` 7�/4�1� <br /> �� PUBUC WORKS PERMIT °°'° <br /> PUBLIC WORKS DEPARTMEM publk Wake Pe�mM� _ 2�Q <br /> 3200 Cedar Street <br /> Everatt,WA 88201 259-8810 Bullding PmmN 11 ___ <br /> TYPE OR PRINT ONLY PuWk Nbrks Fea 3 ��� _ <br /> Acr�e s i.�w u e�,� ��� w. G��., aY E��-� �to� 353- S/SG7 <br /> Iling Atldresa CNy Lp i'hone <br /> �v� JOI�%�ms IIOZ (��d� dr F�,.e/� 44'Z.o3 �S3-ZYS3 <br /> Applicant � Malling Addrea� CNy Zip Phone <br /> Describe Proposed Work � �� �S Pw�l�r:nee, pTT T � <br /> Brtlin tgLvd-- � <br /> � <br /> _ .:.�.:�:.��'� � <br /> PROJECT ADDRESS Qf known) �� V z �� EL�''en �`k• 4��� M <br /> a sca a r. ��� <br /> Attach fovi(4)copin o1 plena ta�xopoaed wak-D/aw to scab and rwta the}olbwinp 6 epplkabN�: O <br /> •PropeAy Unen `Outllne and dimanalons ol all exirling end propoaed etruetures on 1M bt 'E ristlrp and proposW WIIOkn <br /> 4,xnterl.ne of street 'IrMlcate North 'Show any proposed Orading chanpes 'ShoM measurer�enU � <br /> DO NOT WRITE BELOW THIS LINE <br /> PERMIT CONDITIONS: � <br /> 1.All calls for Inspection shell be made 24 hours in advance-phone 259-BE110. O <br /> 2.All work shell tie pertormed in accordance with this permit and cument City of Everett Design and <br /> Construction Standards and Specitications. <br /> 3. Call Locatlon Underground Servfce 48 hrs.before you dfg. TOLL FREE NUMBER 1-800�42�-6665. H <br /> � C�� �Z�u� T�-� �^ Cc�� d'� � <br /> EI�G'�L� .S�yQQMd ��h 3a� �aPY Q��¢d� o <br /> a <br /> �,�-:_.-�t l. :e:�a�. <br /> f� �e�o� <br /> ,?�;r;-_ •::c.00 <br /> � ������._ zo.00 <br /> L'ASFi �O.GO <br /> ii CM719Q <br /> ��ryg�� <br /> ACKNOWLEDOEMENT OF CONDIilON3 <br /> TAe undarsipned owrwriepplicant he�Wy epieea to Iwld antl seve ham�ises <br /> ! 7,•�� —�e' tM Clty ot EvaiMt trom any and all cWms for damepee.�w�te,aRpenaea,a <br /> App vetl lor O ngf ctlon Date ��of actbn that may arlae beceune ol Installatbn snd md�tlenana ot <br /> the Impm�nent w other rlpM�ot-way ux haeto appNed for and hxlher apses <br /> e�f „ lo �amove same upon notbe hom ths CMy end to replocs pubNc propMy <br /> ,�.�c'el°��•� ur-z.- /.�-S- f� eeme�am�ny. <br /> FINAL INSPECTION Dete y� � <br /> ApProved ns Constructed _..� /" "v� / '���./� <br /> £:gn t otApplMan��/ Dats <br /> WORK AUTHORIZEO BY THIS PERMIT MUST BE STAHTED WITHIN 180 OAYS OF DATF.PERMR IS ISSUED AND THEREAFiER IS 70 BE DIU6EN7LY PURSUED TO <br /> COMPLETION.hIIS PERMR MAY BE CANCELLED BY THE CRY UPON ANY STOPPA6E OF WORK ON THIS PR0.IECT OVEP BO DAYS DUMTION. <br />