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�9tB �� �`''r• •� `� woiKwan�ormn• �S ��Z <br /> a��o.��. f'�/ /.t/6� <br /> Appiicstlon For <br /> PUBLIC WORKS PERMIT � "�ta�»"' • <br /> u..�ow F»v.a � J� <br /> B�qna ow ! //�✓ �/ <br /> Print or Type Only �9 yo/ <br /> � �J �v �v. /zC 3L• 3 /�1��c./l� `'�Sz�� 3.�=yl 9L <br /> w�e� Ma1Nnp Addreee Clty ZI� Phona <br /> /1/. //• f�• � . <br /> Appllcant Mailing Addre6! City 21p Phone <br /> Describe Propoeed Work _�J '� �� /v J'� � 2��� <br /> /t9�Q_-1.s�—C�I � <br /> �,v -I,o �. Lza: �.. <br /> Prolect Add�ees(If known) � ' <br /> Altach lour(4)coples ol pl ns lor p�opoeed wo �ascele�d e lollowing es epPllcable: � <br /> • Property lines • Centerllne ol elrael � <br /> • Outline and dimeneions ol all exletlnq end • Indicete Nort� <br /> propoeed etructurea on tha lot • Show any propoaed predlnp chenpes <br /> • Exletinp anC propoaed utllitlee • Show meesuremenls � <br /> DO NOT WFITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 1. All calls lar Inapection ehell be made 24 hrs In ativence•phune 258•8815. � <br /> 2. All work e�all be perlormad In eccordanee with thle pe�mil and c��rrent City ol Everett Daelgn and Conetructlo� <br /> Slanderfe end Speclllcellons <br /> 3. Call locatlon Underpround Servlce 48 hre.belore you dlg.TOLL FREE NUMBER 1•800•424•5555. � <br /> � SiTE fdo�.t Ta 6'E' CGN/l.-.E�GLi EO �E•c' �1�oj�,�'OVEi� � <br /> �Ge.vS L1R7�.� B —2.�3S <br /> � .I'� � /�" /�.v`^`'.,.` `�"Q.� V: <br /> , ��u Gm.nC..� <br /> � � �-�-�' � C3 <br /> � <br /> ACNNOWLEDGEMENT OF CONDITIONS <br /> I � The untlersignr,tl owneqapPliGenl hereby agrees�o hoitl end 58va harrr <br /> less the City of Everetl Irom anv end utl clalms for tlamages, costs. <br /> � , raoenses, or causes of aclion Iha� may arise because ol instailatior <br /> �i/�,/ � /' n�I antl m:+mienanco ot the �mprovement o�other nghi�obway use neretc <br /> `^�lL+�"' L���-'�1-'=� `�' ���/ apphrd br and lurther agrees �o remove semn upon nolice hom thr <br /> Pcprovetl lor Constr crtoi / ,Oa�e C��y �nd b reo�ace Public proPerty tlamaqetl I�44y. /� / <br /> � ��/z/��, % � � � <br /> F�'JAl iNSPECTION / �•��" ��� ��. �� <br /> Ar.orovntl as ConsiruCtetl I S�qn:�W�n�1 AppVC0�1 � ��� <br /> � Wp17K AUTHORIZED BV THIS PERMIT MUST BE STAR?ED WliHlt <br /> ewrrtt[ PUBLIC WORKS DEPARTMENT 1y0 OAYS OF DA7E PEAMIT IS ISSUED AND TNEREAFTER IS 7r <br /> � 3200 Cetlar Sireet I BE DILIC,cNTL'I PURSUED 70 COtAPIETION. THIS PERMIT MAv 3f <br /> E•�ei�rn.WP 9920t � r:pp1C�LLED i3'/THE CITV UPON tdl'/�TOPPAGF OF WORK ON iN!; <br /> t Phnne. 259�N�:�S � ?nq.�ECTOVfP'�ODAVSDUPl.TION <br />