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HxnH <br /> Crl Cr+l � <br /> A � x <br /> t" yv <br /> pp ��j ^ :� <br /> FC y � D8i@ (��`� S I a�im��.wo�ksae,mn. �/� ��� ���1 _'�J�[[ ��7-- <br /> Applitation For ein� ocoi.+ _t��pcl.�..�5--.--- <br /> � H � � <br /> �/� F"� f`unecwo�MSFce <br /> y PUF3LIC VI90RK5 PER�,� IT ro„�F�� S_ <br /> xz <br /> [�J O �ess nwi cox e ..� S <br /> oHd TO P�STING � �4 �.,,,. , ��,,. s ;��cw _ <br /> H � �7 Print or Type Only — <br /> �V � <br /> � y � /_. L. Snur2 lOG� �-Or•,lr�C�� it fdG� �'S9-�C �,� 7 <br /> H H Owner Mailm�. Atldress City 7_ip Phone <br /> � <br /> H <br /> c� G�" cn r•, � F_N�o�or��P 9 Sam�C. <br /> � LT1 t'� qpplican� M2iling Address City Zip Phone <br /> CTJ <br /> HOfyi� � . <br /> Des^.rlbe Proposed N/ark �u) 1/Af.LA ..tp.tr2tG�. /'P �.(�—_ <br /> � _ � <br /> Project Addiass�if known� G���' — Ib� ��L,l�� ��%�r. _ � <br /> A�tach lour(4)�opies oi plans tor proposed work- Draw to scale and note Ih�tollowing as applicable: �� <br /> • Property Lines • Cenlerline of sireet ♦^ <br /> • OuU�ne�nd dimensions ol ali existing and • Indicate North d� <br /> proposetl strucWree on the lol • Show any p�oposed c�rading changes <br /> • Eeisting and proposed utilities • Show measurements � <br /> DO NOT INRITE BELOW Th115 LINE O <br /> ' ' PERMIT CONDITIONS <br /> ' ' 1.All calls fur inspeclion shall be made 24 hrs.in advance-phone 259•8810. �\ <br /> � 2.All w.orh shall h�:pertormed in accorda�ce with Ihis permit and current City ol EvereQ Design and Construction ♦ <br /> Standards aed Specifications. <br /> f�r 3.Call Lncation Underground Service 48 hrs.betore you dig.TOLL FREE NUMBER�•800•424•5555. � <br /> 1 <br /> 1_I � <br /> _ <br /> 1( � <br /> w1 � <br /> I � <br /> car O <br /> _ � '. <br /> ��� � <br /> — <br /> '� ACKNOWLEDGEM1IENT OF CONDITIONS <br /> � Thc undersiqned ownedapplicant hereby agrees Io hoid and sa�e harm� <br /> N� — �r�— — less ihe City of Everet� �rom any and all claims for damd9es, cos�s. <br /> ///��� expenses, or causes oi action that may arise bec�use oi installation <br /> ��--- ( / � /1� ��� �\ I I _��� and maintenance of the improvement or olher righl-ol�v�ay use hereto <br /> � -�'<< � � ' — �PPlied for anA lurther a9rees to remove same upon notice Irom the <br /> ApP�oved for Constru t� / Date City d to repl. ublic D�oPerty dama9ed lhereby. <br /> / /� �' /f'3� � /J <br /> FINAL INSPE TION ����- � � ��� �" <br /> Approved as Constructed Signature ol Applicant Date <br /> WOFK Al1iHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> everet[ PUBLIC WOHKS DEPARTAIEN7 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS 70 � <br /> � 3:.00CetlarStreet gE DILIGENTLY PURSUED Tp COMPLETION. THIS PERMIT MAY BE <br /> Everett,W�98201 CANCELLED BY THE CI7Y UPON ANY STOPPAGE OF 6VORK ON THIS <br /> Phane:259�8810 PROJECT OVER 90 DAYS DURATION. <br />