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��� PUBUC WORKS PEAMIT �a � <br /> Pueuc worms n�a,wrMExr wex�wa�a,,,,w« 9 <br /> 320o ceo.r sd�, <br /> Everett,WA 982p1 259-8810 <br /> BuMdnG PannB M <br /> TYPE OR PRINT ONLY ��k�a�__ ` +/G <br /> /v <br /> �ol�,.Mtsl� 9ae�2 2��o F�u�� Ettr 4d.�o���q - ad.�-5 <br /> ownar Mdu,q A�e� � <br /> �P Pln� e <br /> �o► ME — l�In <br /> Mw��� n�i�ne� <br /> �' �P afane <br /> Describe Proposed Work _ G' U 2 f�, rc Me V AL S o Sc c� <br /> �2,v4 wk.. ��_�sc � � �, W <br /> i-� ,-,. _ � <br /> �..E.",r�.,,--�- � <br /> PROJECT ADDRESS(ii known) _ w ' v� � <br /> nna�n ro��c<1�o�w�r,s tor wovosea w«k•orew eo�,,,d�me nb rawwme rc.�p�: � <br /> ��Pe�f'�n� `Outline antl dimenslons of all ezisting erM propoyed y��,y��y p��bt �6cistiny end p�opoyed utllitles O <br /> 'CenterNne of atreet �Mkate NoRh 'Slaw anY MePo�ed 9radBW chanyoa 'Show meawrements <br /> DO NOT WRITE BELOW THIS UNE � <br /> PERMIT CONDITIONS: <br /> 1.All calls for inspect(on shall be made 24 hours in advance-phone 259-8810. � <br /> 2.All work shall be perforrned in accordance with this pertnit and current City of Everett Design arW O <br /> Construction Standards and Spacifications. <br /> 3. Call Location Underground Service 48 hrs.before you dig. TOLL FREE NUMBER 1-BOp.42�.6666, <br /> �� � pa��,d-�►� � S.-�z � l;C. <br /> y <br /> � <br /> a <br /> � � ACKNOWLED6EMENTOFCpNpRIpNg <br /> Tha urMersipned ownx/eppAcant he�ehy epren to hold md seva Mrmisx <br /> App ved for Construction pe. � cauyes of action that eny��c���•�°•e�^N5,a <br /> may adsa neceux a Maf.AM�,.a mw,�en.�cs a <br /> /� the imqovenbnt a otAerriphtof-way use hxMo appllsC lor arM h�lMrepen <br /> ( :[� S.�C'C.4� �� to remove seme�pon rwtke mom me cny ana ro�eplac,pubqc p„pMy <br /> < I'Yi,/aer�.,.�.,� d�a�ed�,. m <br /> FINAL INS EC770N Date <br /> Approved as Constructed , !O ` <br /> ��� ! 'rls�!CLiGM ✓� �q, <br /> Signature of llpplicant '� <br /> WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN 180 DAYS OF DATE pEqMR IS ISSUED ANp 7HEqEAFfEq�g Tp gE a��-�Y���� <br /> COMPLEf10N.THIS PERMIT MAV BE CANCELLEO BY THE CIlY UPON ANV STOPpAGE pF yyq;K pp�h{�g pqOJ��R��YS IX1RATpN, <br />