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i <br /> �q � � <br /> �± , <br /> Date_—(i�a 1 ` r��ni„-w�.�.r.,m�i. — ' ���-- <br /> �y.j -� <br /> APPlicelion Fo� ,_. y�nB Depl • ____ __.___'_____.. <br /> PUEiLIC WOFtKS�EFtMIT �°°��°W°,.°�°°- I��-f— <br /> .o�.��.. s_. <br /> � �P,,.�ai �.�P.ia s_�_ <br /> � ) BT111ni1!D119 �I.3L9 �� <br /> Prin! or Type Only � `�� � �'• �; � --- <br /> ` 4i [� W ln O� <br /> � CJ �O .�� vd <br /> ; � •� � � :: �!�✓� sy5-8o3s <br /> T�z;� e.�n�� Io,� i��l�l�• �.o�'�" 5c-a. �emi� s� —ago3 <br /> Ownr.r Malhng Add�53� � G � Sk � �Ctly 2ip Phona <br /> 'e <br /> H � W <br /> '_--j�a.,����aDrre+,r �l o. Bo �J2 ~���L—__�l.�__`}�'�11 I <br /> qpphcen� Meiling Add�ess Cdy >io Phone <br /> Describe Proposed Wo�k �n �1'� �� Z- _ STD�r' �U� ����1 <br /> �� _Y 11'��� '�' � t�i _ ,I <br /> _ __ W I <br /> Pwleel Addresslil knownl [�,'1Ll��i�C�lS.1.��,e�n- � ',. <br /> � Attach four(4) copies of plans fo� proposed work- Draw lo scale and note the following as appl�cable�. � � <br /> � � Property Liney • Cenlerline ol streel � <br /> • Ou�line and dimens�ons ol nll eKisting and • Indicate North <br /> � p�oposed niructwes un rhe tot • Show any proposed g�ading chunges <br /> .. • Exisling antl propo[:ed atitities • Show meesurements � <br /> . DO NOT WRITE BELOW iHIS LINE O <br /> PERMIT CONDITIONS <br /> 1.All call6lor Inapection shell be made 24 hra in edvance•phone 259•881�. � �� <br /> ' 2 All work ehat!be peAo�med fn accoMence wilh this permll end current Ciry ol Everett Design and ConsVuctlo� <br /> Stonderde end Specifications. <br /> . 3.Call Location Underground Servlce 48 his.belore you dip.TOLL FREE NUMBER 1•BOO•424•5555. � ,� <br /> �� � of�ro�-���i�' a�.�e-� 7-Z¢-S y O i <br /> �/ <br /> � <br /> � <br /> � <br /> a <br /> i <br /> ACKNOWLEDGEMENT OF CONDITIONS i <br /> The urderslgneA owner/applicant hereby agreas to hold and en�c bNrm � <br /> less the Cily ol Everetl Irom any anrf all daims lor danagca, cnsls � <br /> /� � expenses, or ceuses ol oction that mny erise because ol Installallor <br /> '� � �// and mainlenence of Ihe improvemunt or o�her righFubviey use herelo <br /> � ' `` � �'�pa!P apn��ed lor anA lurther ag�ees to ramove sama uUon notice trom Ihe <br /> ov o nelru � n Cdy and m replace pubhc prop�rty danwgea thereby. <br /> FI l� CTICN � �� � ��'� — —4�`—���`T""�T�- �� <br /> Approved as Conalructed 519na ure e� Appl�canl Da(e <br /> WORK 4UTNOFIZED Bv 7HI5 PERMIT IdUST BE STAHTEU WITH�N I <br /> everett PUBLICWOFKSDEPARTMENT 1ti0 DAYS UF DATL PL'RMIT IS ISSUED AtJD �HEREAFTf:R IS 70 � <br /> � 3200Cedm Streel BE UIU�iENTLY PI iqSUEU TO COMPLETIU�I THIS P[HMIT A1Ai'13E ' <br /> EvereU,WA99201 CANC�LLFD 6Y 1 HE GTY UPON ANV STOPP�Gf Of WORY.ON THIS � <br /> Phone�.259�8810 PROJECT OVEH 90 DAV; UURATION. ' <br /> I <br /> � <br />