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�, . .., _Y._ <br />�, � <br /> ., � — I —ZS�� PuULc Wo�hs Pe�mn• � � �ZZ '" <br />, Oate��R� H�aa oeo� • <br />' Application For <br /> PUB�IC WORKS PERMIT P°°'","°""`° S <br /> �I ToteiFee <br /> TO 1 1 i Z S � Less AoOI Fec PeiO S <br /> ��p POSTING B„a��„o�� : zo— <br /> Prinl or Type Only <br /> � � ,.�� ZIJ���� t�� /Jr�'ac q�'G36 y���Q� <br /> ��. a� �Na Cf� Mailin�Address C�ty Z.P Phone <br /> ��� o ow� <br />' b N� �(� �� CitY Zlp Phone <br /> (p�-1 np--p�a�� Mailinq AAdress <br /> �x� ` — — <br /> �o S�le�am,1y h�, � a i a.��������. <br /> OesCribe P�oposed�Nark /P �) <br /> Q�� --. -- — <br /> �y �� _ W <br /> t� y <br /> ~ 582-1 - Glen�Q�i�_1� �"� <br /> g� Prolec�Address(il known) <br /> M � <br /> ��fA <br /> � Attaeh four I�)copies o�plans lor proposed work• Draw to scale and note Ihe following as.ipU��a e�. � <br /> • Prop�.��Y Lines • Centedine ol streel <br /> • Indic�le Norih <br /> y • Oulline antl dimensions o�all exisling and � ghow any proposed c�radin9 chnngcs <br /> O W proposed sVuclures on the loi � <br /> � • Exislin�:md PruOosed utililles • Show measuremenls <br /> DO NOT WRI�E �ELOW THIS LINE O <br /> t <br /> � PERMIT CONDITIONS � <br /> I1,pll ca115 for inspeclion shall be made 24 hrs.in advance�phone 259•8810. <br /> � �� 2 All work shall be pertormed in accc•dence wilh this permd and current Cdy ol Everett Uesign und Cons�ruction <br /> � Standerdc and Specilicntions. � <br /> 3.Cell Lncation Undergmund Serv�ce 48 hrs.betore you dig.TOLL FREE NUMBER 1•800•424•5555. <br /> O <br /> I �� <br /> ♦ � <br /> I I �)wJ <br />� � '_t= r � _/ <br /> I O <br />� . a <br /> ; __ <br /> '=1= � — ACKNOWLEDGrMENT OF CONDITIONS <br /> The undeisi9ned owneUapplicant heinUy a9rees to hold and sa�e harm� <br /> leas the Clly ol Everelt irom any and all claims for damaqes. cosls. <br /> expenses. or causes of actinn that may arise because ol installalion <br /> pA 3_��_ e�' and mainienante ol ihe imp!ovemenl or o�her nghl-of-way use hereto <br /> ��.s.� �.–l�_. •� applicd lor anA Wrll.er a9rees lo remove same upon nolice Irom Ihe <br /> Approvetl,,lor C�onslr'ction / ���P Ciry a�d to repince public o eity da ged Ihereby. <br /> (.�/�'�-f�" /6 /G--L_ Cy-c. �. � -3o-9i <br /> FI AL INS ECTION ���� Uate <br /> Approved as Conslructed <br /> Signalur . o� pplicant <br /> WORK A iH RIZED BV THIS PERMIT MUST BE STARTED WI H <br /> � everett PUBLIC WORKS DEPARTtdENT 780 DAYS OF DATE PERMIT IS ISSUED AND THEREnFTGR IS TO <br /> ' 0 3200CedarSlreet BE DILIGENTLY PURSUED TO COMPLETION. THIS PERA7IT MAY BE <br /> Evcretl,WA 98201 CANCELLED BY THE CITY UPON ANY STOPPAG[OF WORK ON THIS <br /> Phone:259•8810 � PROJECT OVCR 90 OAYS DURATION. <br />.. .'�'"'�c'-i�=.�.+i'..=�.N.w°;:.��:'.-Li'�_ir�_:t'_ �. . <br />