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everel[ APPLICATION FOR PUBLIC WORKS PERMIT <br />� Tvae or print cleariv with ink / <br />PRESS HARD • YOU ARE MAKING COPIES <br />PERMIT NO. ��%"�/� <br />PUBLIC WORKS <br />EVERETi, WASHINGTON BLDG. DEPT. NO. <br />�OWNER C7AGENT DA7E __ep[er�ber 22, 1^i11 -- <br />APPLICANT/FIRM REPRESENTED _General Telephone Company of the North��est, I r_c. ___ <br />ADDRESS 2701 lletn;orc Avenue CITY `verett TELEPHONE ��9-4725 <br />HEREBYAPPLIESFORPERMISSIONTO Construct, operate and main[aln undcrgrn��nd conduit <br />��nd manholes to supporC cooununication Cables <br />AT THE FOLLOWING LOCATION <br />(See attached prints ) RE: W.O.�{208-7II96i381 <br />(1 thru 5 for locations.) <br />Attach five (5) copies of preliminary plans for proposed work. Draw to scale and show the following as applicable: <br />' Property lines and street identity. " Topographic changes requiring cuts and filis <br />• Outline and dimensions of existing and other than normal foundation. <br />proposed structures. ` On-site drainage systems when required. <br />' Existing and proposed utilities. ' Erosion control methods when required. <br />* Centerline of abutting right of way. ' North arrow , , <br />, - ,;_ - � � ; ��r' l . <br />�:'�,.f, _��' � <br />---'�-�-�-�' ig aNre o1�Applicant � <br />PUBLIC WORKS PERMIT <br />CONDITIONS: <br />�-J..,��No�C >"` :;�0 � L'o�����%rr- c.yrL;uU�.Uc� ?�� L�����c7T—,�G�c <br />1N1 �-C. BE �oiUS/OG/�ED %v 8E /� PE�2My,UC-lUT FiiC/L, 7;' <br />�N I Thi 1?G�PE� ?d l��UDF�G2DlJ�U,� UTI L/7-ICS e 7`I- <br />THE. : C/�CL'�-l5 �lUCC� ,� Rl SE 7N�T . RE�G/�5N M�.:�ti"i =" <br />p./�E �C-l�U/2�1� TN� TWo �/�/ZT/ES t.�i� i�GSaL� �_-_ <br />.TNE. : :MoST E�V� iRl3[t sv��70�c1 pd55/,�L�� <br />' ?� I <br />� � ����e undersigned owner here6y agrees to hold and seve harmless <br />G.. �--^�-'-�--�1he.Gily..pi Everelt irom any ano an clalms for damages, cosls, <br />expenses, or causes ol eclion thal may erise because ol installali0n <br />�- end maintonance ol ihe improvemen� or other riqht�ol-way use <br />hereto applied lor and lurthcr agrees to remove sama upon notice <br />Irom tho Cily and to replace pu6lic properly damagea thereby. <br />S � �7 �aZ, <br />DATE <br />ACKNOWLtDGEMENT OF CONDITIONS <br />� �; ��'�`� � , , . <br />f SIGNATU O APPLICANT'-- � � DATE <br />PERMIT IS VALID FOR 1 YEAR — I I CALL FOR INSPECTION <br />POST ON 25g.gg1 � <br />EXRiRATION " � -= JOBSITE 24HRS.BEFORECONSTRUCTION <br />