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� 5'FoA 9/oie � �I7 <br /> 5 2 � 95 �q (�C T r OCT 2 2 19g]; P„�,���:�„sN,.�m�� <br /> `S <br /> Date� € 9P p 6A 3 F ��V - n�na o�o� • � -- — <br /> ApPlication Far ____ <br /> Pu1�TolaacnrF•1� 5 <br /> PUBLIC WORKS PERMIT <br /> Less Anol Gc�•Pa�.:l 5_T— <br /> 2 /J <br /> . naianrrf:ue $�7� <br /> Print or Type Only <br /> 1� s�^� n T�1 ' ��X�i���U '�U 1 ��_�Lv� �Z��C�>e� �z,L•j <br /> (T�r c�� V�� �L�IyUQ-1� y��'-_ Ti� Phnnc <br /> \^;t�•iii��� :�r:UfuS51. ��'�> <br /> �WOP.I � _ <br /> . i _. . � .. .. <br /> _ .. — —___.� rih,�-_. .'iP '—___ Phon—_�___- <br /> qpplicant G1..�i��'�:; ,1ddn:ss' <br /> Describe Pronosrd Work �2 V �� _�'il L I._I_`�'��_�_L`±--�-s TU�-`''F�_� w+'�'��--- � <br /> (L1 � � S',_T_'F�-Cf.0 A���"I�L4J�;1dfJ_ <br /> 5i1�/i-°i- � "(��P v5`P.R�'!'Y-►J---� — -L4-� �— <br /> c � '�laH D�J:��o u -- ------- _-- ------------- W <br /> _`_ --,--w��,, .Z � <br /> - - ----- <br /> � �� _�l�_I_NIifL_��V-- r:.����y_�. �s?��--- <br /> Prolect Address Iit knrnvn! - <br /> � <br /> A�tach lour(4)coP�es of Plair:toi P�opuseJ wo�� � Dna. ta ">�i�� .u��.7 nr��r tnr �o�lo�;�mp as anUhcahie � <br /> � PropOrty LineS • Cente�hnr nf 5t�eei <br /> • InAir.al•. Norlh <br /> • Outlme and dimensions ol all exishnc, ;�nd � ci��,�,;���y ;reDosed iyadmq r,han.�rs <br /> propo5ed 5truc�we5 on ;he �ol � 5��,�W �n��asuremenls M <br /> • Eristina and proposed utihties W <br /> DO NOT WPITE 6ELOW iH15 LINE O <br /> � PERMIT COP��ITIONS � <br /> 1.All calls for inspection shall be made 24 hrs.in advance-phone 259-8810. <br /> 2.All work shall be performed in accordance with this permit and current City ol Everett Design and Construction <br /> Standards and Specifications. � <br /> 3.Call Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1-500-424•5555. <br /> 7. G%di�L�vr� tn /�- o�vrie�zfl�L�»S �i�J�O�i'�'� O <br /> �� T/,e �%rr_f/`f?•GC:ti Lc.'or�s D�� B -/-9� <br /> � �'� f/ c✓.CL i�a:fa:lC Z;r f��cfc rS S�o�,�n oh PLon S, �//� <br /> Coh�r'acfl�✓' .:uilC i�.rf•� LC_ S�ffers �- f�oXe� an�/ c, C� V♦ <br /> Ot/Cr G�J4f��- li�� a� �Oi-.���. ��o�'cr�� O <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> Thr�under���ned o�vneNaP� ��nt tierebY aQrees Io hold and save hnrnr <br /> �� /�c,C SrEJ N6/L53E ----- --- --� I�•ss Ihe GitY ol Everetl Irom any and all clams fur Aa�n:�qc;. ,-.�>sts <br /> i <br /> / ; C����,�iS�;. or cause5 ot aclion Ihat may aris� be[auSe ot instollatien <br /> / � . � ,�nd m;iu�ienance o� inr imProve�nent or piher ri9ht�ol�waY use hereta <br /> �� � J S � �,��n,,;. �„� �nd furthe� agrees tn remo�•e same upon notice irom Ihe <br /> Ap ovetl lor C ns ru tlo � � ` �'"�'. — . ('�,v ii,d tn",Nnc'' r �I'c ^tv da 9� thereby. <br /> - �li <br /> � / l Z� � c �U <br /> ,� �/ - � � <br /> FIN �INSPECTION ����� � - a�� <br /> �� nnn we nf App��can' <br /> Approvetl as Canstructed � �ppK .4U7HORIZED BY ThIIS PERMIT MUST BE STARTED WITHIN <br /> /A� I <br /> PUBLICWORKSDEPAFTMENT I 150 DAYS OF DATE PERh11T IS ISSUED AND THEREAFTER IS TO <br /> � 3200CetlarStreet BE DILIGC-NTL1' PURSUED TO COMPLETION. THIS PERMIT MAv B[ <br /> Everett.WA 98201 I', C4^JCELLtD BY THE CITY UPON ANV STOPPAGE OF WORK ON i HIS <br /> Phone:259-8810 I F�O.iFGT OVFR 90 DA�S DURATION <br />