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��� <br /> �� � � <br /> � � x <br /> C M <br /> 9HCn <br /> � <br /> H � <br /> �yN� y � D21B //i��' Yc � - ���m���vo�wsvo�mn. <br /> 9�/ zc. �� r <br /> App�ication For E+�,�a ocn�-� <br /> �y� PUBLIC WORKS PERMIT '�°°T�;;«�`°°_5- <br /> O N �y �ess noo���cc va�n 5 — <br /> H [�s] O eaiance u��c 5 <br /> H� � Print or Type Only <br /> H �/ <br /> zH <br /> gy y ,.�7�c_�t.s�-C. �!�-.�;t �,Lc�-.�.� �t.,� �.3 L� �.el�- �..! ,Y Z••� <br /> H Owner Mailing Address City Zip Phonr, <br /> c� OqN <br /> LT7 C ,� ,• <br /> � ---_ <br /> y � � Applir,ant Mailin9 AddreSs Cily Zip Phonr. <br /> Describe Proposed Work �' ` — � � �'' �`��� —r�=Cs---- <br /> ,�7 W <br /> ProlectAddressUf knowm � 7�G �`—���"���'��`� —�-- � <br /> Attaeh four 141 copies o�plans�or proposed work- Draw to scale antl nole the lollowin9 as apphcable� � , <br /> • Properly Lines • Centedine ol sirect � '� <br /> • Ouiline and dimensions ol all exis�in9 and • InAicate Norih <br /> pmposed s�ruetures on the lol • Show any proposucl 9mA�n�t chan9es <br /> ��" • Existin9 and proposeA ulililies • Show measuremenis M '. <br /> I C_, DO NOT WRITE B[LOW THIS LWE � I <br /> PERMITCON�ITIONS O �� <br /> 1.All calls lor inspection shall bc made 24 nrs.in advance-nnone 259•8810. �\ <br /> 1 f�� , 2 All work shall be perlormed in accordance wi�h�his permit and current City ot Everett Desi9n and Construclion ♦ ' <br /> , ��� Siandards and Specihca�ions. � <br /> ; 3.Call Localion Underground Service dN hrs.belore you dig.TOLL FREE NUMBER 1•$00•424•5$rJ�J. � � <br /> ��� II <br /> � � � �� / .I � � % � � � I <br /> /-L�G'�C<� lc'czl� ��� _ �, � rf .=I�'c�r� ,����t�c,.. � <br /> � i <br /> � , � � ,,��'>c��l - �A I <br /> '�.+. �� � 7 •!r- V♦ <br /> O/� <br /> � ��..�.�� 1� II <br /> i <br /> I I <br /> I �1 � ACKNOWIEDGEMENT OF CONDITIONS �� <br /> l � <br /> � i h��undersi9nad owner;apP��cant hereby ag�ees to hold and save hainr <br /> ---- --..—. _ -.... .--- . . . - ..- Ics: Ihe CAy ot Everelt Irom any and all claims lor damages, costs � <br /> c.penses, or r,auses of action tha� ii»y arisC Uecause of inslallatio��� '� <br /> an�' maintenance Of ihe improveinent or oiher ngh4o4way use heret��� � <br /> applicd lor and lurther a9rees Io iemove same upon notir.e ��om Ihr � <br /> Approved for Conslruclion Dale City and to replace pub�ic propeiry Jama�eA Iheieby. <br /> i <br /> FINAL INSPECTION Date — I <br /> Approved as Construded Si9nature ol Applitant ���� <br /> WORK AUTHURIZED BY THIS PERMIT MUST BE STARTED WITHIN . <br /> cvrrril PUBLICWORKS�EPARTM[NT 180 DAVS OF OAT[ PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200CedarSireet OL DILIGENTLV PUFSU[D 70 COhiPLETION THIS PERt.111 A1AY BE � <br /> f'_vcrett,WA98201 C�N('ELI.CD [3Y TH[ CITY URON r1NY STOPPAGL O�AMOHK ON TNIS <br /> Phone:259�8B10 Plit)Jl(:1 OVI.H �l0 ��11'ti �I�R�JIC�N <br />