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� ` f <br /> � � <br /> b� � � <br /> �H V� �f f�,Q µ OO y�,(//� <br /> �8�e �`"/ `"�' Pub�¢Wor�ePnrmn� . �l J ��`� <br /> �� � Applicxtion For I mnn n.m .__ . ,�. <br /> PUBLIC WORKS P�RMIT - — -- - <br /> ��� �,,,,,,�w,,,�,�ee -- <br /> lmni Fee f <br /> LOf�ApO��!!Pnri1 S <br /> �� g g o.�,�«o�. S�� <br /> i,�, d Print or Type Only � <br /> � � > <br /> ��g ��-� ��� �.� , �. ������f ��l�u��� �= �c�� q�: iZ <br /> ` �� Owner Mndiny Adtlress N � � � Gty ip Phonc <br /> � � U <br /> � H �-f�c�i s <br /> � Appl¢anl MniLng Adtlress Cdy 7.ip Phonef <br /> �u� Describe Praposed Work `��e"� �'��'„�• "� C��� ��� <br /> ay <br /> Pwlect AOtlress 1�1 knownl , �-�S 1 L�� ` <br /> A��ach low�4)copies ol plans lor proposed work� Draw to scale antl nole Ihe lollowing as appl�cahlr� � <br /> • Proparly Lines • Cenlerlme ol stieet � <br /> • Outhne nnd dimensions ol all eMisling and • Indicale North <br /> proposed s�rutlure5 on Ihe lot • Show any proposed grnAm{�chan9rs <br /> • Ezisling anA proposed ulilihes • Show measuremenl5 � <br /> DO NOT WRI1E BELOW THIS LINE O <br /> � PERMIT CONDITIONS <br /> � 1.All calls for inspection shell be made 24 hrs.in advance�phore 259•8810. � <br /> i ��� 2.All work s�ell be pedormed in atcordance wilh this permit and current City ol[verett Dr,sign and Cunslruchon <br /> Stendards and Specilications. <br /> � 3.Cell Lucelion Underground Service 4B hrs.belore you dlq.TOLL FREE NUMBER 1•800•424•5555. <br /> �� � <br /> y ��� ��� ��Q�,� �� ����.;��d O <br /> � � . <br /> __ .s 7',��.�.,,�t�f� J��� ��.�e� ���y �-� . H <br /> � � � <br /> ; <br /> I ��—' � <br /> a <br />, '; �� <br /> AChNOWLf.DGI_InL1JT O�CO�!')IiIONS <br /> llu�un�l��nignrtl ow�no�iaPPlicnnl h��ivby m,revs t:�ho A and snvc hmm� <br /> �t�� �— less Il�e City ol Evmelt hom any anU all Ua�n��s lor tlamnges, cosis, � <br /> � erpen,es. or r.auses ol achon �hN may ense Pecause of installalbn <br /> � �� ��, - `/ �� nnA mam�ennnce ol Ihe imprnvemenl or olher n�hl�obway usn herelo i <br /> - appbed lor ;md Iwtl c� agiecs to remove same upun nolr;e Irom Ihe <br /> APP�oved for Const ct� Dnte <br /> Gry.ln Ip rr IIf1 . Pubhr.P�preitY Aama9CA I'iereby �� <br /> �q /7-� 'r ' <br /> FI INSPECTION Datr, / _ �x i� II, <br /> Approved as Conshucted 5 , nlure o Applir,anl Dnte i <br /> rvrrrll PUBIIC WORNS D[PARTMENT WORK AUTIIORIZLD OV ?HI PERMIT MUST BE STARTED WITHIN <br /> O JPOOCedar5lreat 1B0 DAVS OF �ATE PLRMI IS ISSU[D AND THEREAfTER IS TO II <br /> Everelt WA9B201 BE DILIG[NTLV PURSUED O COM11PL EiION THIS PER611T MAV Li[ <br /> Phonm 259-BB10 CANCELLEO�V TH[CITY UPON ANV STOPPAGE OF WORK ON THIS I <br /> PROJECT OVCR 90 DA�r JURATIDN <br />