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1 <br /> I <br /> � <br /> i vq P.,o�,�v,:,.,=��,m,,, �/�3� <br /> DatB�� / s �me oeoi • <br /> App!ication For <br /> R KS PE R M IT °,,,,"`"'°'.'`"` <br />' PUBLIC WO ,�,r�.�� 5 — <br /> I � �„� F�..�,.,., s_��— <br /> ,:....r..�.. 5_��-- _ <br /> Print or Type Only <br /> ✓urTT" q�z�y—.-�3n�'07/3 <br /> /7r4A i'YI�,I�/If��// c 5"0/ � lB/dy _� �,,,, ,�, <br /> ; �. <br /> Ownei Ma���� �y nr,diess - <br /> ly�f/yL -- � .___— Git.� Zip __. __--pi.;,c. -- ___ <br /> ApplicaM <br /> M.��I��rGn Pddrr55 <br /> L1< .i <br /> p 1tG>'/_HcG ---�L��.¢ <br /> Descri6e Pronosed Work __/-���� ���A"�--T"- <br /> ����.—_����e __B/�n�c_ —0.t --c��__—o�c _P�'-�-�___-- <br /> -T� �sc�nr�---�9_2�_--- — - --- -- W <br /> Proled Address 01 known'. ��'-�J-O� —���y�-- ------- ----� --— — � <br /> � <br /> AUaeh tom 14) coP�as ot plans to� nrovu>ed wo�k-Drau: �a =�-J�..�nn nc.!�'�'�� . �terlin� ni sUerli�.ah��: � <br /> • ProPerty L�nes � 1^�!icab� Norlh <br /> • Out�ine and dimen5ion5 O�a��existinq anA � ci��.w any proposed U��h�n�) �:r.�3noo•> � <br /> proposed st�uct�res on the Ini � chnw m�asurement[�� <br /> • Eristing and nroposed utiGbec, <br /> � DC NOT WFITE BLLUVJ iH15 L�NE O �I <br /> PERMIT CONDITIONS � � <br /> t.All calls tor inspedion shall be made 24 hrs.in advance-nhone 259�881 O. <br /> 2.All work shall be performed in accordance with this permit and curreM Cily ol Everetl Design and Construction <br /> Standards and Specifications. � <br /> 3.Call Location Underground Service 48 hrs.betore you dig.TOL��A�ER�e B�4T/eNA�.s�'1�-�- �JAL <br /> �. Au. F►u- M�ta¢��+t1�Fzvnt �7cisr,�v6- �ti y , �r O <br /> �(e BF' B�U6Nr �N10 T)ir Si�' . <br /> � <br /> � <br /> O <br /> a <br /> ACKNOWLFDGEM[Nf OF CONDITIONS <br /> The undnrc�aned owner/apPl�cant hereby a9rees to holA and save harm� <br /> C�K�� /J],l(E r,l�qb --- —�'—� less the Gdy o� [verell liom any and all clalms lor damages r.nsts <br /> � exPensBs. or causes o� �C��o� �hT� may aris9 hecause ot inslallatioi� <br /> �] � � anA maintenanr.e �! 1he improvement vr other r�ght-obway use heieto <br /> � �, ✓1/Il//p // ����_ ii ,a�pi�nd tor anA �uriher aUrees to � ove samn upon notice Irom Ihe <br /> /v/� •C 7 Cate . ��,,y .i��.d to r�pla . Public Or ertY ama9ed therebY. <br /> q�proved tor�'r)Strudion � i � <br /> �� i jo�3-y'� ; , <br /> � � � D�tc I — - — — Date <br /> FlNAL INSPECTION I gi, na . e o� An iean� <br /> qpprovedasConst�ucted LNORK ,aUiH 91ZFG BY THIS PERMIT MUST BE SIARTED WITHIN <br /> ��7 PUBLICWORKSDEPARTMENT �AO p YS - DPTE PERMIT IS ISSUED AND iHEREAFTER IS TO <br /> s� I �E DILIGE TLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> i�� 3200 Cedar Street <br /> Everetl.WA9B2a1 CA'JCELL U BY THE GTY U'ON�NV STOPPAGE OF WORK ON THI <br /> Phone:259�8810 'i PRO.IECT OV[R 90 DAYS DURATION. <br />