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�: <br /> �,.,.,- ""�� <br /> �,�� <br /> 1 . � <br /> /- � ^' / <br /> � ��(}��` Pv[r�¢Wo�waP�nm9 � �� <br /> �t@�(. , , "— piJ9 De�t • <br /> , Applicalion For -- , <br /> PUBLIC WORKS PERMIT °„""""""„`° s <br /> Tmei F ee <br /> ��� ,� Leaa AoO�fee V��a s �—��' • <br /> � Batan:eDue f _� <br /> � � Print or Type Only <br /> ��� �t,� +.ar �rY����> ';�'�'�.''� .�I=�� S t�11 �� I�? C`��11'�'�S y��. <br /> ��� Owner Mailin9 Atltlress <br /> CnY L� Phone <br /> ��� C,�Y Z�p Phone . <br /> � � qpplicenl Mailing ANdress <br /> �i� (�'�1 l) �F-1" �L`�T �-�� 1��.-'� {�� <br /> : �� <br /> �q Describe Proposed Work __�r-_—s--- pF LoT � <br /> Q` % AAlO GG�.42iNG — <br /> �M � -�- -_ _ - W <br /> �p 8/29 - .���--n�- � , <br /> �� � Proiect Add�ess iil know^) _ .. <br /> �� . Attach lour 14)copies ot plans br proposed work� Draw to scale and note�Ceotedme ol slreet ,�Ir. � <br /> • Property Lines • Inditnle North � <br /> _ • Outline and dimensions cl all ea:shng and � Show nnY Groposed p�ad�ng Cha��0e5 <br /> . p•oposed structures on the lot � Show measuremenls M <br /> � Existing and proDosed ullhlies W <br /> . . _.,y ,. 00 NOT WHITE BELOW THIS LWF O �y <br /> � ��� '�,�, PERMITCONDITIONS � - <br /> yi 1.All cell6 fo�in8pecl�on shall be mode 24 hre.in advance•phone 2S�SE1 O. <br /> ; I ��: � z A��,wp*Spa��ye peAormed in ac.^.ordance witP ihis Dermit end curreni City al Evereu Des�qn aatl Constmction <br /> Slendards and Specifications � <br /> � 5 3.Cell locetlon Underqround Servlce 40 hrs.be�orc you dig.TOLL FREE NUMBER 1-800'42O•5SSS. <br /> 1 i <br /> ' '� ,�/ QQ�at�4. �✓,L.�t`�i <br /> ;I� �,�'� j, �LTYL^����yc .�Pw+�T�/i�1 �4�✓ � cLM/ .l.c� .�La:.�� O . <br /> pFi 4.� /r�+.�f l�X�.f c+r�u�+• /�A.o /ovi' . <br /> ' � � ZUv. ��� � 1. <br /> I �� �' C'a��Q. .fe.E� �e� a/�c>e� �i(s� /�n�.�G .�� �f/�✓ ♦/� ;. <br /> « ¢# �,� p,,�,. ..�t`...,.�.�.,.!»i'`zo5 s� �o o�.�:u�:� � .�4Poai� u:�w 000axzeso �/h/ <br /> `� ��i (,�JCt.fi- L+w�ea2�inl, c� N00013437 O 'i <br /> _ �� :20.� a <br /> , �� � .S C��a,�l u, �.�"Du9i+��re� Cu�vE,¢7 �D6K Dzv�'� . szo.a� <br /> �,�oG,�,,1� "r3z6 <br /> . • _I lo. C�°'��2�''`q�'`�' ���h,f� �c6e+.¢3o' o{ <br /> V� � _�0���� � ACHNOWLEDGEMENT OF CONDITIONS <br /> __ E��a ��y �'( The undersigned ownedaOP����^�hereby agrees to hold antl save harm- <br /> � -- less Ihe Cily o� Everet� ����r, any and all claims for damages, costs. <br /> :6 expenses, o� causes o! ����On Ihal may anse because o� installation <br /> / ��L�G� anC maintenance ol ihe improvemenl or other ngh4obway��se hereto <br /> ^� �/yf �,(������c[ applied �or and �uriher agrees to romove same upon notice irom Ihe <br /> -� � Dale Cit1'and te replace pubhc properry damaged ther:by. <br /> � i, Approved fo onstruction <br /> - �L /�,/�� ,Iln i i"11 � h � e � �Cl(� ��O <br /> Date '� / a k-�L y—��`" ate <br /> �� FINAL C I Signature of APPIicaN <br /> � Approved as Constructed WORK AUTHORI2ED BY THIS PERMIT MUST BE STARTED WITHIN <br /> � everett PUBLICWORKSDEPAR7MENT 180 DAVS OF DATE PERMIT IS ISSUED AND THEREAFTEF IS TO <br /> 3200 Cedar Slreet BE DILIGENTLY PURSUED TO COMPLETI6N.THIS PERMIT MAY BE <br /> Everett WA 98201 CP.NCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS..-. <br /> �+ e phone:259•8810 PRUIECT OVER 90 DAVS DURATION. � <br />