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�ate�L��r,'� �.,: �,•: .,���_.,,,,,, 8g `33Z <br /> ���,,, o.�� . _&q�.,�z�6L, <br /> Aoarcano� ��o� <br /> P�IBLIC WORKS PERMIT �°°'"`"°„_`�� -- �- -- <br /> H C� <br /> H ro�.,�F�� s- <br /> �+ry LessAppl.F¢ePaJ $ — —�- <br /> n'�?1-� 2al.incr.Dun .�. ��m - <br /> ��H Print or Type Only <br /> C x� <br /> H ?3 <br /> "cz� j�,� (��c � If' �' ar�l3S t=1rn l)r �i���ei' �i8"D� h 3��-/lODri� 35�5� %S_y.� <br /> O x O Owner tdading Atldress GIi ZiP Phoi� <br /> '7 H"�J <br /> �H <br /> � SRYN �. <br /> [x.y Or Applicant Mailin9AtlArc55 GIl' Z�P P����" <br /> H C7 <br /> zot7 (� � / / lan.�;�i La� /� s� /�-�4'8' <br /> H C�]O i)<�-scnbe Proposed lVork 15��i���I-2 A�•V �Ci/ir�(���i,Lt — <br /> �� n � i i <br /> aH� <br /> t" H y W <br /> C7 fn <br /> O H — � <br /> � d�n /�f� G.7'N Farr �-�y��P _ <br /> P�edecl AAdress Id knOwnl <br /> � �� ..tt�ch tour 14)COP�es 0�Ptyns lor ProPOSBtl work� [lra:•. ��. �.,..i - .�i+t1 nol�. �4�.!nilovnny as dPPhr..d.-� � <br /> 2 H f/� • Gcnteil�ne o�she��i � <br /> y Q� • Properly Lines <br /> • Outline and d�mensions o�a:l c.�sNnq n��d • Indicale Norih <br /> prOposed StfuLtureS On Ihv ioi • SM1ow any Proposed gratl�nq chnnyrs <br /> O Existing antl pi�Posed uhlib�^_ • Sho.v �nea;uremenis /� <br /> W <br /> DO �lOi t:��17E1 BELOtv iNIS LWE � <br /> PERMIT CONDITIONS <br /> � t All.alls for inspeclion shall be made 2a hrs in ativance-phon�259-8810. � <br /> ''�' ? f,ll work shall be pedormetl in accordance with Ihis permit antl current Ciry o�[vereu Uesipn and Const«ic;ion <br /> ; StandarAsantlSPecificaUonc. <br /> 3.Call LocatlOn Underc�round Scrrice ae hrs.h�:lau you diu TOLL FREE NUMBER 1-800•424-5$5$. � <br /> �-,.- -,,,� � <br /> -�, <br /> ,�. .—„ 41♦ <br /> � __� � <br /> � ; <br /> a <br /> { aCKNOV✓LE�G[ME�JT OF CONDITIONS <br /> ��,;!� � Theundersu7nedowner/npphcanihorr.hyagreeslohuldandsavcha�in- <br /> � Ic;s Ihe City oi Fvereu from any anA all claims lor damages, r.o�,�s. <br /> expenses. or causes o� aC�ion Iha� may anse because ol inStallaiion <br /> ` qL'/ E_c� Flntl mmntenance ol tl�e i�*�provement or othcr ri9h4o�-way usc h�xetn <br /> � � �CS� � `�1 -FC� � ( � � " 1 applied for and �urihm ai7rees lo remove same upon notice Iroin ihc <br /> .'�t�r��o�ed lor Dnsiruction ���� GI � to ieplaae pubhc prnnerly amaged Ihereby. <br /> / � <br /> Ci; �/ i. ;� /:1�7��/9/ �` /���(' /�'.L'� f�-��F h-�� <br /> fI1�AL INSPECTIO��� Da�e ---�nt�� <br /> Approved as Cons��ucled Signalwe ol Apprcant <br /> WORK AUTNORILED BY THIS PERMIT MUST BE STARTED WIt11IN <br /> rvrroit PUBLICWORKSUEPAFiTMENT 1p0 D�YS OF DATE P[RM111T IS ISSUEO AND THEFEAFTER IS TC <br /> � 3200CedarSireet Fi[ �ILIGI:MI.Y PURSUED TO COMPLEiION THIS PER�11T PdAY 6E <br /> Everetl.WA 98201 (�.d';('.f.l LI D f1Y �11F CITV UPUN AP1V STOPPAGE OF W0�71<ON 11115 <br /> PI-�onc:259�8810 PR�7Jf CI (�A9�ia�:lU fL1Y i DUIiAIION <br /> i <br />