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�,mi�cWm�sPr ����- I}���7� <br /> Date tiY��_p� ; � <br /> O I mn� o��r� • ���L:S-- <br /> Ppphr�imn For <br /> F'UBLIC WORKS PEf3MIT ''°°'°w°"°`��. <br /> y�H .o�,�F<� s— — <br /> �M- m� <br /> t.,csAnni r��.V.�i-: S-- '_—'_. <br /> a y �� � <br /> e.,.,�-�.��,. s_;;,� . <br />� 9 y n Frint �r Type Only — <br /> rx <br /> y z� —!� <br /> .� � l;7}12C� �yl�10 �;C.?� �� ��_ ►���il I �a��'" 9�O1.� '�/'�-«'�� <br />� O ..'CO Ov:ner MaihngAdtlress City Z�p Phcne <br />' "�J H'� <br /> y V�C !l 11 <br />` x z� --- <br /> I Cd y� .lpplicant 1+lailin9 Atldress Gty Zip Phonc <br /> � �8 ��—�-Et.� [.C� j5 ��F'►��`''L, <br /> F-� C�7 Cescribe Proposed Work < -- i <br /> �Y �] <br /> z � — — <br /> a y -- <br /> r �+y 1 � 1 <br /> y W <br /> H � <br /> O C7 Ga �7/� — FD/.-_FNJ['C.0 L/✓, � <br /> q C r Prolec;Address lil knownl ----- — . <br /> 3. [+'1 <br /> Z �-]G7 AttaCh�our I�I CoprS ol plan5�Or prOpOsr.tl w0�k� nrav: b stal�•,�nd note Ihe!O�lowing as appliCahic � 'i <br /> H O V. • Pronerty Lines • Centedme oi strer.� ♦^ <br /> � Outhnn and dimension5 0l al�ceisLn:� a�uf • Int]icate Noith V� <br /> �rOpOSntl struCiUfBS on iflc ipt • $hUY: �i1y p�OPU�'d yr��:ir.q Glanyes <br /> • Et�sbr9.ind proposed uti6tu�s • Sho'.v �n�•asurrment5 � <br /> Cl ^:L� NFllf. dELM:' THIS LING � <br /> PER611T CONDITIONS <br /> !_ 1.All calls Icr inspection shall be made 2•1 hrs in aUvance-f��one 259•8810 � <br /> � 2.All wark Shall be pedormed m aCcortlnn:��::�tl�thu peinut anA currenl City ot[vnmtl Des�gn nnd Conslrucnon <br /> ""`! Standards und Specilications. <br /> 3.Call Location Undergrr,und Service 4B his.�elo�^you di� TOLL FREE NUMBER 1•800•424•5555. � <br /> Q� f _. ' <br /> .aw� <� i!c�, e.":,<t� < y�t-:�.-, 'y . .^i:ah Ccc�- .] •�� +' . ,/a.;(.c ,.•� � . . Jy, � <br /> �/ ,�,/ / ] � � � �/ � [ <br /> �e � /71U � /LE�I'< i/ .CCG7�J �Q,�':i' C.«tA n��ll.'n-Q'/Z•Zr!"7/ .3G.:� .�' ,� (' <br /> ' 6. p L <br /> .�` - r <br /> �s. , Q ;, <br /> J Ll�t?-tr..�l �J1c'cc' .^_-cr.t�•«`��� / [�:_ .,1.� . . -.i , . -. . � � <br /> " v+ ! �-r- ..� � � �- . <br /> �� v ') 't r'� . , , .. .. ,I. � - � . , . O <br /> � <br /> � 1 <br /> ACK'JOIYLEDGGh1[NT Of CONDITIONS <br /> +' The undersi9ned owneynppl�cant hereby agrees to hold antl sa�e harm� <br /> less Ihe Clty of Everetl Irom any and all claims br Aamage>, costs. <br /> /�J / eMpenses, or causes ot achon that may ariso b[+[ause of inStallaGon <br /> ' �°�CJ /,�j /� �n - 9- .Y J and m�intenance ol Ihe Improvement or other nc�hPot�way use herelo <br /> �`R •�� applied for and lurthe� ac�iees to remove same upon nolice Iwm the <br /> Approved lor Conslru t� fi Date C�ty antl lo renLice public property damaged Iher�by. <br /> ��/ � <br /> , /��/!//'I f' � i` - <br /> RNAI INSPEGTION Datc <br /> Approved as Constructed Siyi�.�lure ol App6cant Date � <br /> VJORK AUTHORIZED BY THIS PERMIT MUST BE STARTEJ WITHItd <br /> iwrrc�t PUBLIG WORKSDEPARTtdENT 1gp DAYS OF DATE PERMIT IS ISSUED AND THEREAI TER IS TO <br /> � 3200 Gedar Slreei Be D�LIG[NTLY PURSUED TO COMPLETION. THIS PER�.1i� IdAY BE <br /> Everetl.N'A 99201 �ANCELL[D BV THE CITY UPON ANY STOPPAGE OF WORn ON THIS <br /> Phonc:25��8610 Pi,UJ[CT OV[R 90 D�YS �URATION. <br />