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<br /> &tl9 Dept• __
<br /> Applir,ation For
<br /> �U�LIG WORKS PERMi� F�it�acwoasFee
<br /> To�,�F�� s
<br /> Less4oni Fnepn�� S
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<br /> Balar�r,.L�� $��n
<br /> Print or Type Only B�
<br /> /f�a r/C .Se L6</ /2 2'L - SP.�.'n/C—B.eoo�F �4D �k STEd�r/S 981s�' _
<br /> Owner A�aiiinr..4ddress Gity Lip Phnn�:
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<br /> q�:plicant �d:,�lmc,Address CitY �—'ip Phone
<br /> Describe Pr„aosed VJork _�L h S��t L L _Q Or'!ve���`/Q� a� 4- ____
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<br /> � ' �� 5��, .f�ycl�/� fo,--�—d�io��—z`���o.�sr�,-��f�� --
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<br /> Proiect Address lif knowrd � ��Z � �O« �r' �
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<br /> A�tach tour(d)COpies of plans foi P�oposeU work-Drav: to �r.aia an0 note Ihe' lollOwing a5 applic3blp. �
<br /> • PropertY Lines • Cen�erline of sireet ♦�
<br /> • OWline and dimensions o� all existing �nd O In�icale Na�ih M�
<br /> proposed s�rucWres on Ihe Ici • Show any proposed gratlln�j r,h�ng��s
<br /> • Existing and proposed utilities • Show measurements �
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<br /> DO NOT WFITE BF_LO1V lh�l��INE �
<br /> PERMIT CONDITIONS
<br /> 1.All calls tor inspectien shall be made 24 hrs.in advance-phonc 259•8810. �\
<br /> 2.All work shall be performed in acwrdance with this permit and cu«eM Ciry of Evereti Dc;ign and Consiruction ♦
<br /> Standards and Specifications.
<br /> 3.Call Loca�ion Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1•800•424•5555. �
<br /> � /��ZdL� I�il�vc.'�ua�/ �-1P.-oa-� �'ror-� �.s�:ny �
<br /> ASP/�uCf' � ps^�//Jer'ff/ Gii�e,
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<br /> '�/ ACKNO�VLEDG[PAENT OF CONDITIONS
<br /> 1 he undnr�ianed ownedapplicant hereby agrees to holA and 5ave harm-
<br /> � ���� --- --�—i ii•ss Ihe Gty ot Everett Irom any and all claims for dama9es. cos�s '
<br /> /J evpense . or causes of �ction th�t m�� aris because ol install:i ; �
<br /> � �i.��� � � �� 'n� m in�emnce n� Iho improvi meN or oiher ri�ht-01-�'�ay u5e h<� �t,�
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<br /> ApProved Io�nS�rue�Ion Dalr, .. ., r i. .�,.,.. � � I . pron•� � �f i.��aged �hrreby.
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<br /> FW L WSPECTI N � � � Da� _—-- -- — --
<br /> App�oved as Constructed , Si9natw�� cf %�npi�cnn' ����
<br /> � PUBLIC WORKSDEPARTMENT I `.NORY. AUTHORIZED BY THIS PERf+11T MUST BE STARTE� WITt11�
<br /> I 1f30 DAYS OF DATE PER�v11T IS ISSUED AND TH�REAFTER IS TO
<br /> 3200CedarStreet BE DILIGENTLI' PURSUED TO COMPLETION. THIS PERMIT �dAV B[
<br /> �-�T EveretL WA 98201 I, CA^JCELLt.� a'/THE CITY UPON A.NY STOPPAGE OF WORK OfJ THIS
<br /> Phone:259�88t0 . PRO.IEGT O�/ER 90 DAYS DURATION.
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