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q <br /> �i �y7 �' <br /> � :v x <br /> Q M <br /> � �y � . I I'�M1na.\Yw�s Pnrmi�• I <br /> H x H Date .1�LLfd9 . . ' _S� � �./S� ( <br /> „ini, n��u� . �w, <br /> � H] � Applicalicn Fni <br /> � " � PL� BLlC WORKS PERMIT ' °`""°""`° — ' <br /> v� H ,��.,�F�� 5----- <br /> �x � �......,,�,,,� ����.,:.., s_ I <br /> � o.�e�...:�,o�0 5 I <br /> O �y-+ d Print oi lype Onty <br /> �� g a.s�-��� �I <br /> �Y �] <br /> zi-+� � VrLii (\u,V.lv� l�r�J � / -!-�_'—�,� ��_[��_�,��/ � /_�PiAli� l��'ar � <br /> -�-� y y � OHner —} ���iny Aatlress ��ty Z,p [� Phone <br /> H y �J��JfO]f <br /> H � ' <br /> g`� � ,�.�,� 1�,.1 A, e. -'f�'3 c�s�t�e��, i 3 i3- s��� <br /> �� d y ��� h1ailinc�Address Gty Zip honc i <br /> �� r APPlican; 'i <br /> I1 (� �J/ I <br /> 'ZH [�p J �Q � �' - 1�tS Y'�j�lf.�}N:S/-' v`-f/h� r��_ <br /> H O �n Descnhe Proposetl��ork _L�'1L��l--�-���dQ.i' � ' � <br /> ---- � <br /> — I <br /> , 3�0���_��u� W i <br /> L,� - .5�� t-/cc� ' <br /> F'rolect Atldress 1�1 kn„wn) �"�������AY'--.1T-1��— � � <br /> Mtach lour(4�cOpiCS o��lans for propo5�d work� D�,l�:�Io scaii,ind notc Ihe lnllo�vm9 as apnlicable: � � <br /> • Properry Lmes • Centeihne o�slrect ♦^ I <br /> • Ou�hne and dimensions o�all existmn anct • Indicate Norih V� �, <br /> pioPOFetl 5irucNreS on ihe lot • Show any propoSeA 9tadmg changes � <br /> • Ex�shne� and proposed u�ildies • Show measuremenis /y� � <br /> DO NOT WRITE BELOW THIS LWE O I <br /> � ' i <br /> � PERMIT CONDIiIONS I <br /> ��'. 1.All c�lis for inspection shall be made 24 hrs.in advance�phone 259•881Q � <br /> �� 2.All work shall be pedOrmed in accordancr with Ihis permi�and curreni Ci�y o(Everetl Desi9n and Cons�ruction I <br /> i � Standards and Specifications. I <br /> '�� 3.Call Location Underyround Service 48 hrs.bebre you di�.TOLL FREE NUMBER 1-800•424•5555. � <br /> ��� <br /> � � . . _. � � i� i �; /� � ' O I' <br /> ��f. ; �-.' , -� <br /> � �__, ,��./�- � _ . . _ ., �, . , � - . � <br /> � _: _��� ' , '' �— <br /> � , �%_ -��� - , <br /> -� -�: � -;', (� <br /> ��1= O ���'I <br /> ,- <br /> a <br /> _�� <br /> � �CI:NO�NLEDG[�d[Ni OF CONDITIOkS <br /> � � ��� Thrundoisiqnedov:neraUPlir.nnlhuiebyagree5�oholdandSHvehNnr <br /> � ---- -- ----�- less ihe Cdy ot [veieti �rom any ;md all elaims lor dama�es, cosls. <br /> ezpenses. or causes ol aclion Ihat may a�ise t�ecause of inslallahen <br /> anA mninlenance ot Ihe improvement or other nghl�ol•way use herelo <br /> applied fo� and hu�her ayrees to remove same upon nOtice Irom Ihr <br /> Aopioved for Consuuaion Dale Gty�nA to repince PuUhc pioner�y damaged ihereby. <br /> FINAL II:SPECTION Date _— <br /> Approvetl as Cci�tilru�:�ed Si9��atwe ol AUUlicant Da�e <br /> WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED W�THIN <br /> �.�.i���.�� PUBLICWORKSDEPARTMENT 180 DAYS OF DATE PEF7A11T IS ISSUED AND THEREAFTER IS TO <br /> � :7200 Cedar Streel BE DILIGENTLY PURSUEO TO COMPLETION. THIS PERMIT M11AY BE <br /> E:cre�I,WA 99201 C�NCLLL[D E�Y THk CITY UPON ANY STOPPAGE OF VJORK ON TIi15 <br /> Fhonc 25J�8810 PRO.iLCi OVLR 90 DAYS DUH��IION. <br /> � <br />