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..;� <br /> �"� ' �q <br /> Date `� -11. —`�O r„m��wo�w�.c�,mn. � 1�$ 5 <br /> F�C� �.---- <br /> .a M APPlicntion For c�na oem . .y��_.2._9'.Z+�B--- <br /> ��� PlJBLIC WO�KS PERMIT ��,���;;,,��;;;��� : ---- <br /> l�sa�no�fq!pqnl S� <br /> � O n.,�,,��.n�. S 20 ' <br /> �,y� Print or Type Only _ _ <br /> N — <br /> m9oG <br /> oM C ��'+��'G—1�OM E� Z`�GYs H Cr(r' A�/ C3v��-�--�?01 -•L <br /> Owner MpdmgAAd�ess CnY Tin Phone �� <br /> ��g <br /> "` � S�I� <br /> �y APPlicenl M1lnilingAtltlr�ss Glv Iip Phone -- <br /> g�� Describe Pronosr,d Work N C^\�/ sl nlC--� L..t:'='�AN I L-ti' tZ,CG I p�rle�- <br /> � O tn ------- <br /> Pmlec�Adtlressld knownl 21 � --r� C-L-.E'�/�[�.��_��(_,__ _____ � <br /> Altach lom(41 copies 01 ptans br proposetl work-DraH�lo sc:Je antl note Ihe lol�owing as apP��c;,blr � <br /> • Property Lines • Centerhne of strcet /_ � <br /> • Oullme and dimr.nsions ul all existiny and • Indi-ale Norih V; ' <br /> proposed 61ruClureS on�he lo� � Show any propo3etl qraaing rhanyry <br /> • E�lsling an0 proposed ulilities • SP,cw measuremc�nrs � <br /> 00 NOI WRITE BEIOW TNIS LWE <br /> PERMIT CONDITIONS O <br /> t.All cells loi Inspecllon shell bu made 24 h�s in; lvance�phone 259•8810 � <br /> 2.All work Shnll be padormed in eccortl�nce wdh Ihis permit and current Gly ol Evr�ett Desipn nntl Construclion <br /> / '� Sinndards and Spar,ilicetlons. <br /> f � 3.Call Loca�icn Underground Scrvicc 4H h�,.brlore you tli9 TOLL FREE NUMBEN�•BOO•42O-SSFi5. � <br /> I �. <br /> �' <br /> 1 �� O <br /> � �-- <br /> � � <br /> I -- 0 <br /> i "_' a '�� <br /> � <br /> ArKNONLCUGEMENT Of�CUNDITiONS <br /> ' �' �1' ____"_'_________'__' _ Tn��unticrsiynedownevnppLcanthriel;Y�9reesloholdandsavehvm� I <br />� � lexs Pir Gity ol Rveretl Irom any and all cla�ms lo� Aamn�jes. cosls I <br /> e,penses. or causes ol achon Ihal may nnse 6ecause ol installaLon <br /> -t�a���n e.��- -,�' _�.t —�Q nnA mainlenanr.c ol the �mprovement or olher rigM�ol�way usc here�o I <br /> I �� Approved lor Conslryc(�pii -- �OPlied lor and lurlher n9rees lo remeve snme upon noGce Irom Ihe <br /> � J Do1r City anc�to rpplacc publir,property Aemayed �hereby- <br /> \ '.'"C�-�j�� . � f_//�,'•Lr <br /> FINAL INSPECTION p��e <br /> Approved ns Constructed Signalme ul AnVlicanl Date <br /> ev��rrtt PUBLICWORKSD[PAR1MCNt W��7K AUTHORIZED �V THIS PEfiMI' MUST C1E STARiED WITHIN <br /> � 9200CetlarSheet �9D DAYS OF DAT[ PERMIT IS ISSUED AND THEFEAFTE{7 IS TO <br /> Evere�t WA9B201 �E DILIGLN7LV PURSUEn TO COMPLETION TIIIS PE{71dIT M11AV Bf. <br /> Phone 259�BOtp ���NCCLLED�V iHE CITV 11PON ANV GTOPPAGE Of WORK c)N iHIS <br /> PHOJfCT OA'CR 90 DAV i DI1RA11pN <br />