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� � � <br /> m � x <br /> C H <br /> 9 �7tn <br /> � <br /> H �h �' <br /> HY. � / <br /> H xl <br /> � x 7' D2i0��� v��oi��woas ae�me. g—Y <br /> yy � / -- <br /> oia�:� onn�.•— <br /> z Application Far <br /> �yd PUBLIC �fl(ORKS PERIVII7 '°""""""`�` �.' —� <br /> �o,.,,Foe s ��� � <br /> � o g �e,�ao�� Fr�P„� s • <br /> c�� o —�'-- - <br /> H l*1 ez'ance o�m S �v '— <br /> �"� Print or Type Only <br /> zH� <br /> yx <br /> ��� � � / <br /> a <br /> gv' r-� I �l�) ualla � t,miD �r1�S (�i l�rr �1 � /�, i ' � lr iio -��1�� fPc�7��e Ss��-- '//�'.— <br /> n C C/� Owner Mailing Address ity Zip Phone <br /> t� r <br /> � e� <br /> z y v, �;„ ��tip -- — _ — <br /> y �y Ppplicant Mailing Address City Z�P �'�1O^� _ <br /> Descril�e PropOsed\VOrk � 'e'Y /'-�'� �e— _ ��� ���— — <br /> / _ � / /� � <br /> Froiect AdtlressUi knownl 7 r7L0 C—C�.�2_��[£���,J"✓�' . � <br /> / Y <br /> Atlach lour(4) copies ol plans for proposed wo�k- Draw to scale and nole�he following as applicaLle: � <br /> • P�operty Lines • Centerline of streat � <br /> • Ouiline and tlimensions of all ezistin9 and • Indicate Norlh <br /> proposed s�ructures on�he lot • Show any proPosed�jraCing chan9es <br /> /�� � • Existin�and proposed utilities • Show measuremen�s � <br /> � � <br /> � + DO NOT WRITE BELOW THIS LINE <br /> iPERMITCONDITIONS � <br /> '�0 1.All calls for inspection shall be made 24 hrs.in advance-phone 259•8810. �g0 <br /> ; �q� 2.All work shall be perlormed in accnrdante wilh this permi�and current City ol E��erelt De�i-�n and Cons�mction ♦ <br /> �� Standards and Specifications. <br /> ' � 3.Call Location Underground Service 48 hrs.bebre you dig.TOLL FREE KUMBER 1•80U-424-5555. q <br /> � f <br /> p �,.�� /C�i'-S ��c�� %D �-'f'�^�j � <br /> � '�" � �� /j�r � OS/02/86 12:14FFS OOORN0394 � <br /> / � <br /> H0009765E <br /> ��+ DFL20 4656.25 � <br /> F6; PC, 91164.8F <br /> F'UItISr 17�80.50 � <br /> CHECl; 991f;.63 <br /> i ���� � <br /> l `14t AGIWOWLEDGEMENTOFCONDITIONS <br /> �- - Th��undcisigned o.vner(apPllcan�hCreUy agrees to hol�l and snvc hartn- <br /> —" less the Gty ut Everetl�irom any and alt claims for damogec, r.osts. <br /> � expenses, or causes o� aclion ihat may arise because el insL�ll;itinn <br /> and maintenanr,e nl the improvemenl or olher right�of-way usc herclo <br /> apNied lor and lur�hcr ayrees to remove same upon n.�t�o• liom Ih� <br /> H rU�.'d-f r C�on ction J �' ���e City and lo replace public properiy damaged ihereby. <br /> l 'l ;� — -� <=� � , <br /> , <br /> � � _ � � �_ d 5 a,�; <br /> RNAL INS E�TION ` / � � i Datc .�� rm/1 �y _� �— <br /> App�ovetl as C�nstruc�ed ignaWre ol ApPlicant ��" <br /> WORK AUTFIGNIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> �.��.��.t� piiRLIr,WORKSDEPA�Tb1GWT 1B0 DAYS OF DATE PER�11T IS ISSUED AND THEREAFTER IS TO <br /> � 3200CedarStmet BL GI�.IG[NTLY PURSUED TO COAIPLETION.THIS PEf7M11IT L!�V E3!.- <br /> [vcrell,WA 98201 CANCELLED 8Y THE CITY UPOtJ ANY SIOPPAC;E OV 1'JORK.OP7 THIS <br /> Phono�.259�e�W PROJ[CT OVGR 90 DAYS DUH��'�ON <br />