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a�y � N <br />�y9 <br />C y <br />��s <br />K y <br />O [q� <br />� N N <br />Y <br />� .� � <br />H � �G� • <br />!' y � <br />Fi �3 <br />N <br />� O N <br />� � Cr9 <br />O v7 <br />I M_ ':� <br />.� <br />__� <br />Datr_ —__--� - <br />qppllcalicn f or <br />pUBLIC WORKS PERMIT <br />Print or Type Only <br />/L�<<� <br />� � �1'' e <br />ng <br />i <br />� <br />i�; h <br />/b'7Y ���-1� _ <br />C��v <br />l.i/� /�/ �l <br />, �,w a�.p� . _— _.— _ . _ <br />--- – �N <br />r��t�ec Wr,.�• fc�� � <br />,��.,� F« 5 - ��---- <br />�..ss aoui r�,. v.��u S�—_ <br />o,,i,�,.,.o�c 5 �--� —___ <br />. � �l� l� L' ,i :. ., � � i G �–' <br />7in Phonr <br />�— tdamn9 �au�c:,� � � <br />qpplmant <br />%/�' %'//v �L !%' <br />Descri6e Proposed �Nork /.� �N /� –�- � _-- <br />on��� <br />�—'—__ <br />Proiect Address 1�1 k•�ownl <br />Attach lour (41 copies o� Plans br propose.d work - Drav+ to sc:fle eantl note ���°�����.ne oi SUee� aU�e- <br />• Prope�lY Lines • Indicate North <br />• Outline and dimensions o� a�l ex�stin9 and � Show any proposeA 9ratlm9 changes <br />proposed strucW res on ihe lot • Show measuremenis <br />• Ex�sbn9 and proposed u�ihties <br />_„ .,... �n�oirr aFi nW THIS LWE <br />PERMIT CONUITIONS <br />1. All calls for inspection shzll be made 24 hrs. in �dvance - phone 259•88 <br />2. All work shall be pedormed in accordance with ihis permit and wrrent City of Everetl Desic�n and Construclion <br />Standards and Specilications. <br />3. Call Localion Underground Service 48 his. before you dig TOLL FREE NUMBER 1•800•424•55 . <br />FINAL INS1'I <br />Approved as <br />evciMt <br />� <br />l: <br />PUBLI� WORKS DEPARTMENT <br />3200 Cedar Sireel <br />Everett. WA 98201 <br />Phcne:259�8810 <br />i� <br />O <br />� <br />O <br />a <br />ACKNOWLEDGEtAENT OF CONDITIONS <br />The undersi9ned c.vnedapP�icant hr.rehy a9rees to hoid and save ham'� <br />- less the City ol Everett Irom �ny and all claims fo! dama9es, cosis. <br />expenses, or causes ot actmn Ihat may :+�ise because ol inslal!ation <br />, nd maiNenance cl the unprovement or olhe� ri9hl-ot�way use hereto <br />Date � C�ity a�d�lo reploce�puUl c�propoily�damo9ed herebyn notice Irom �he <br />�� � .` , ' � o� -2-, _ <br />/j / j ,�� <br />�= � '�� � oate <br />Dale <br />SiJnNury�'o� Apphcani <br />80RD VS OF D�TE PERh117 SEISSUED AND�THEREA T�ER ISHTO <br />BE DILIGENTLY PURSUED TO GOMPLFTION. THIS PER�11T IdAY BE <br />Pf70JECT OVER 30 DAYS DURAT ON STOPPAGE OF'NORK ON THIS <br />