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PUMa Wo�•+Vn�mit< ,�. <br /> % 7 <br /> � Date /� � `, �/ � oina 000� _-_���� i <br /> � nnPlicali�,�ur � <br /> � � r � ' v�ne�wo�F�r��� — <br /> �` PUBLIC 'h+ORKS PERMIT T��r�«� 5 <br /> �p � Less 1pu�Por PaN <br /> C H 5 <br /> � � y 0aianrn Oue <br /> � I' Prinl or Type Only <br /> ° � " � �� ��� N � l i .� ,�, ���.�: �7��'i�s 31�3 •.h/.�/ <br /> r7 Phone <br /> tC IC � �1 � Mailin�Atldress Z p � <br /> � � ' Owner J <br /> r 1 / /;'"� 7i�' �I �s= 19�F��' �Q�:I�I�� ��1'l �i^ �G�3'� l.�rl <br /> � :4 �l � � A i I �I/%���I.� � / ! Zip Phone <br /> y y � Applicant . • <br /> Mailm9 Hddress C��V <br /> Y �� -� <br /> r� I �. <br /> N <br /> �y y Describe Prop�sed Wo�k � <br /> p H <br /> n O N i <br /> � r <br /> � � � � � I <br /> � <br /> � prp�er.l Address 1if knowN � ��1'` � � <br /> Atiach lour In) coPies of Plans for PmPosed work- Draw Io scale and nole. Cenlierline ot sir�eet a�la. /A � <br /> I � property L�nes • Indicate Norlh v, � <br /> • Outline and dimens�ons ol all existing anA � ghow a�Y P�oposed�radin��chan9es � <br /> ���I proposed sirucWres on Ihe lot � Show measurements M <br /> � • [aistin9 and proposed ulilities W I <br /> � DO NOT`�'RITE BELOW THIS L�NE O i <br /> I PERMIT CONDITIONS � <br /> i,All calls for inspection shall be made 2�hrs.��advance-Phone 259•8810. <br /> �"� �� 2.All work shall be Pedormed in accordance wdh ihis permit and current Ciry ol Everett Design and Construclion <br /> I ��' I Slandards and Specifications. � i <br /> i 3.Cell location Underground Service 48 hrs.belore you cig TOLL FREE NUMBER 1•800'424-5555. <br /> 1 � � � ' <br /> �__ � <br /> ' ���� � /�, ! � r./G. � ' �,�;7'� ; � ,. - ' � �"�. � � <br /> f (J/-'���' � i': � : � < ' � � , <br /> y , <br /> i '__' / %C/— / ` . .� O <br /> � . a � <br /> __ � - � ., � � ,<<- .ti � - <br /> , , :, <br /> � �, <br /> �.� �;i ._' � �., , . . -;;a: . ;c�_ - <br /> G ,- ,, i—. � . <br /> -f-/;L- �_' � ` '" " �� ACKNOVJLEDGEMEN7 C`-CONDITIONS <br /> � ' , <br /> `'�1 �he undersi9nEd owner/aPP�ica�t hcreUy��9�ees to hold and save harm� <br /> less Inc C�ly of EveieV ��om any and a�l claims lor damages. r.osls. <br /> eapenses. or causes o� a�-��on ihat may arise hecause ol installat�on <br /> I � and ma�ntenanc? ol U�e improvement or other n9hFof�way use herelo '. <br /> � apn��eA loi and lurlher a9rers lo remnve same upon ��oUce Iwm �he �, <br /> i � . Dale C�ly and lo replace,xibhc proPe�N dama9ed Ihereby. <br /> �\�'�� Approved foi ConsirucUon <br /> I — Date — — Datc <br /> I FINAL INSVEGiION S�9naiwe ol ApFlicant . <br /> � qpprovedasConsD��::�eA WORK AUTHORIZE� BY TNIS PERMIT MUST BE STARTED WITHIN <br /> I evemtl PUBUCWORKSDEPAR7MENT 190 DAYS OF DATC- P[RA11T IS ISSU[D AND 1HEAEAFTER �S TO <br /> 920pGedarSireel BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT IdAY BE <br /> ' I�� EveretL WA 9B201 pROJEC7 OVER 90 GAYS DUFAT ON ST�PPAGE OF WORK ON THIS i <br /> � � P�one:259�8810 � <br /> :—�.a,:._____. -_,. _'_'._' <br />