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� � f � !A � � 1 � � <br /> 0-/5-`'�-' TO POSTING_��_ �����`.p����iO � <br /> Uate �•- wm<won.r.,mn. <br /> r <br /> ApO�icoti0�For aiay neoi• � g.Z�w'� <br /> PUBLIC WORKS PERMIT °�°;e;;,::`°• : — <br /> '� i.ueoc�renr�m S <br /> �� n c�i o i-' i i�� u r�o �� o n e.in�c.o.e S ZO' <br /> Print or Type Onlg� , . . . . : • <br /> m o � -n :�c, � ���� .: o <br /> �: m .. m .�� : r i ,:.. "� c� �,/� 7 �/��.�.��.3�I-Sla2�� <br /> /�jrt�-7f� .^ « " � :5 f1�S �' C�d�cu/O�''�L[UC- �v <br /> , Y <br /> Owner �.. .��i i�M�iNn AtlOre9�:—��� =o -" - CitY Z�p Phone <br /> ti o . �oa �. i � i �•-. n" i3 <br /> � c � � ni 1nc- � �' <br /> ��� ni..2n � .� a � �i �: � � � <br /> Appl¢ant Alailing AEdress City Zip P�ono <br /> Descnbe Pruposed Work �����=7�p ��L'�-����� <br /> r <br /> �� W <br /> ProjeCt Add�ess lil knownl � � <br /> Allach lour�4�cop�es ol pl�n5 br proposed work-Dww lo sca!e and nolo Ihe loltowing as apP�icaUle: � <br /> •PeoPerry Llnes •Centedine olsVeel /w <br /> •Outlino antl d�mensions ol all ezisting and •Intlicnle Norih V� <br /> prOp052tl s�NCIurQS On tlle lul •SIfOw Ony propOSCtl pladin9 Ch3ng05 <br /> • Existing and V�oposed utilities •S�ow measurements Y <br /> f� <br /> DO NOT WflITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> t.All calls lor Inspection shail be meCe 24 hrs.in advanco�phone 259•8810. � <br /> 2.All work shall be pedormetl in ectordance with Ihis permit and tunent Ciy ol Eve�ett Design entl Consimc�ian <br /> Stanearas ane Svecili W Iioni <br /> 3.CnIILocatio�UntlergrountlService48hrs.beloreyoutlig.TOLLFpEENUM8EN1•800-424•5555. � <br /> O <br /> ■ <br /> � <br /> O <br /> a <br /> A ACKNOWLflDGEMENT Of CONDITIONS <br /> �� Thc underv�7netl ownm/appbwnt hare0y apree5lo holtl and Save naun� <br /> less Ihe Ci�y ol Everetl imm any anC all clalms lo� ifamaqes rost�• <br /> �J � en eRpenses. or causos ol nclio� IMt may ariso becad;e ul inslnllauon <br /> �� (J �y��V � 1�_ZS_� und mainlenance ol Ihe improvement or ot�er ri9h��m�.•.ay use hci�•io <br /> `Ll��--" � ��R� applie0 lor antl lurlher ag�ecs lo removo samo upo�� nutmc Iwm I���• <br /> AppmvCtl lor Conslmc�ion Do:e City and lo replace pubbc pw�e�ty damngotl Ihoreby. <br /> ,� �/ �' /�[� /J <br /> t r'C!-��— ���U " %3 J �-O'L�Q�-C <br /> FINAL INSPECTION Oale �� a _�_��—. <br /> Appiovetl as Conslmctetl Signaluro ol Appl�i.:ant Dale <br /> �qp�i�� PUBLIC WORNSOEPARTMENT WORN AUTHGRIZED BY THIS PERMIT MUST BE STARTED WRHIN <br /> � 9200Codxr5lreel �80 DAVS OF DATE PEFMIi IS ISSUED AND iNEREAFTER IS �O <br /> Evaua.wn9B201 BE DILIGENTLY PURSIIED TO COMPLETION THIS PERMIT MAY'B[ <br /> P�O�u:259�BBt0 I CANCELLEDBYTHECITYUPONANYSTOPPAGEOFWORKONTIIIS <br /> f'ROJECT OVER 90 DAYS DURATION. <br />