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_ ,,. _ <br /> �(: <br /> ��� 4C.I v.o..wo,�s n� '%f'' �.�'�" <br /> D3te J <br /> �,��,� oa�� . ��_.��-��-�3 <br /> APPhr,alinn Fm __._ _ __ . _ <br /> PUBLIC WORKS PERMIT °"°"`""°"„`° <br /> iO�TI F�C `S' — <br /> le'SSApI:� !rr Va..f 5 . <br /> TO POSTIN e,�.,���o,,.� 5�N p�"'�"'�� �' <br /> � <br /> �C� Prinl or Type Only G__1_�_G: -4'3 ,_ , _ f;,,; <br /> < <br /> y <br /> ��� r � 1� P �� I��51� `��'i�r a �' ( �� (1'� i I I ��F����� <br /> 9 H C6 ����-j Ma�hng n�fdress CitY 7 P Phone <br /> r x ow�e� <br /> � �� �� , t _ _ �3�-L``'��3� <br /> O� H� Applicant Madmg Address City Ln Phone <br /> N H � �Y <br /> � �� Descnbc PrOposctl Work � <br /> H� — <br /> OH - <br /> � �g - - w <br /> n. � <br /> zH� -- � <br /> a y 7/r C% `� .� � �' �i� (�l .,�,i> �) -. <br /> t" H� Project Address Uf known� <br /> g �, — <br /> ,. Attach fo.0 141 copies of plans br ProPosed work- Draw to sc;de and note ihe tollowing as apphcable�. � <br /> O d� • Property Lines • Centedine ol street <br /> � �r. • Cutline and dimensions ol all ealstmg and • Indicate Norih <br /> ry f�OpoSed 5iructure5 0�Ihe Ioi • Show any pwposetl grad��9 Changes <br /> y H�y , • Ezlsting and proposed utduies • Show measurements M <br /> W <br /> DO NOT WRITF BELOW THIS LINE O <br /> PERMIT CONDITIONS � <br /> 1.All calls lor inspec�ion shall be made 24 hrs.in advance-phone 259•8810. <br /> �.All work shall be pedormed in accordance with ihis permit and current City of Everett Design and Construction <br /> Standards and Specilications. � <br /> 3.Call Location Underc�round Service 48 hrs.belore you dig.TOLL FREE NUMBER 1-800•424•5555. <br /> ' , f� �,- lc/C':� �• i.< <�'�i.L. ����t. j.)��: .c : ��-t•<<,� �/- .J'-•.7% <br /> i O <br /> ��4!��t�wr ��. <br /> � / i 1 <br /> �� / -/ �/ / [ / <br /> `•� I J�. /�`-_n��=t-srry Lb/ /'l�C�Yi1/3. J//!eL'/ l�f.. 2 ;hzC�i�.e�.e[C�,✓ l � � — l�l:.�t:- � <br /> � ' � 'i� �' �/ . . , , / . � <br /> �-,,.:�/�_l� r:A�,> / ✓/ c'�«�/� <br /> �— .... <br /> �� O <br /> � ,_,; a <br /> ! "'� ACKNOWLE�GEMENT OF CONDITIONS <br /> r'.! <br /> The underslgned ovrner/apPlicanl here6y agrees to holtl and save harm� <br /> less the City of Everelt irom any and all claims lor damages, cosls. <br /> enpenses, o� causes o� action !hat may anse �ecause of installation <br /> ��' ' / LJ // `, �� and mamtena�ce ol the improvemenl ur othe� ��9ht�of�way usn heretn <br /> ��( /� [>i["�/'--- applietl lor and lurther ac�rees lo remove same upon notice trom Ihe <br /> Approe,:tl lor Construction Date d to replace pubhc properh,�damaged thereby. <br /> • �- /'p��� � �-/� . F�{��=-7`�/T7 - <br /> FINAI. NSPECTION z � C� /' �',"'' <br /> ApprovedaSCOnsirutletl S�,naW�e � 1PPIi[an� <br /> WORK A F ORIZED 8Y THIS PERMIT MUST BE STARTED WITNIN <br /> ��.�i.�i.�� PUBLICWORKSDEPART1dENT 180 DAVS OP DATE PERMIT IS ISSUED AND THEFEAfTEa IS TO <br /> 3200Cedar5lreet BE DILIGENTLY PURSUED TO COMPLETION.THIS PERMIT h1AY BE <br /> Everell,WA98201 (;ANCELLEU BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phenc'.259�BB70 Pf7pJ6:;T OVER 90 DAVS DURATION. <br />