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`7 uyy [ �����'.., 7��{��/ <br /> �8�8 / � � L PuONe Walu Pxmn� ___�?�'/ CLJ— <br /> B1Up.D�pl.• 7- <br /> Appllcstlon For CJ <br /> PUBLIC WORKS �RMIT °�°�W°�F� <br /> Tot�l Fw / <br /> �n��w�F«ww • <br /> Print or Type Only � g �.,,M.o�. t .�`�G s <br /> � � <br /> %/Se /9'�,i�a Cb, ,'?o. Bc�1'3�07 �I1sLbrA�6 cs'e4ffi�e G/o, yB/2f�-72a7 .�5�2-sB7B <br /> Owner� MelHnp Addres� � City 21p Phona <br /> � � � � <br /> OC.�iiGer _ g V <br /> Appllcant Mellinp Addrese City Zip Phone , <br /> Describe Propoeed Work fe!<t'i^ 1�"' y� • �J�.9 �t�il�r!:�aJ 9nd tr[in.f �I <br /> Set✓2r ��- Con�ce�ion !`c, f/� /ciBS� <br /> - W <br /> Pro�ect Addreee(II known) -�no 3 - Lv� C � <br /> Attech four(4)copiee ol plsna lor propoaed work• Drew lo ecele end nole Ihe followinp ee eppllcable: � <br /> • PropeAY Linee • Cente�line ol slreet � <br /> • Oulllne end dimenelone ol all exletinp and • Indicete North <br /> propoeed etiuctu�ee on the lol • Show eny propoeed prodlnp chenpes <br /> w Exlatinp end propoaed utlllllee • Show meaeurementa � <br /> DO NOT WRITE BEIOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 1.All celle lor Inepectlon ehell�o mede 24 hre.in edvence-phone 25P8810. � <br /> 2.All work shall be perlormed In accordence with thle permlt end cunent City of Everett Deelqn and Conetructlon <br /> StandaWa and Speclflcatlone <br /> 3.Cetl Locatlon Underyround Service 4B hro.betore you dip.TOLL FIIEE NUMSE111-800�4Z4b6b6. � <br /> � C.�1pr�E t� BC �ry,C OCr �drt.�' �1c'L`[r.�' ��-S/ �LZc/J O <br /> n / � A C/ <br /> Y,C��.� !<l�/� !�.Y` Qav j-ZS�'�J/ ��.�d' 7�-9�, <br /> 07/:�/91 10:46RM OOORq8033 � <br /> i �M00053^c06 <br /> PWINSP O <br /> PW PC <br /> CRSH �0.00 � <br /> ACKNOWLEDOEMENT OF CONDITIONS <br /> The underelpned owner/applicant he�eby eprees to hold and aeve harm• <br /> leea the City ol Everell irom eny end ali clalms for damegeq costs, <br /> expaneea, or ceuaee ol actlon Ihet may arise becauee ol Inelalletlon <br /> 7 ���q� end malntenance ol the Improvement or other right•ol•way use heralo <br /> ' epplied for and further apreee to remove eame upon nalice Irom tha <br /> Approv one ctlon Dete Clty and to replace public property damaped thereby. <br /> l �' .�;,�. �y� <br /> - o <br /> IFIN L I ECTION Date <br /> Approved as Conatructed Slpnature ol Applicant Date <br /> � PUBLIC WORK3 DEPARTMENT WORK AUTHORI2ED BY THIS PERMIT MUST BE STARTED WITHIN <br /> 3200CedarSlroot ' 1B0 DAY3 OF DATE PERMIT IS tSSUED AND THEHEAFTEI IS TO <br /> Evereit WA 98201 I BE DILI6ENTLY PURSUED TO COMPLETION.THIB PERMIT MAV BE <br /> Phone:26B•eB10 CANCELLED 8Y THE CITY UPON ANY 3TOPPAOE OF WORK ON THIS <br /> PROJECT OVER 90 DAYS DURATION. <br />