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Date�` _Y .�u __ <br /> '7f �•1. n,e,��r.wo,w.re,mn. .�' [� <br /> Appllcatiun For n���a n,m •— _ <br /> PUBLIC WORKS PERMIT �����;o,,;;,���° s - _ <br /> Lete�no� �ee Pud S <br /> PriM or Type Only <br /> Bainran0ue f <br /> To o.� B.�cso <br /> /�e ti'oe.,�o Co, f.�Q t;c.�.Y -i 7c� 7 n�� Of- :C. �S'c/1Lc lc/o. 9B/, 7 `' <br /> ? �HF-o sr._,, <br /> � Mailing Address Ciry Zip Phone [�n f{ <br /> �S4�nC. <br /> Applicenl Meiling Address Ci�y Zip p��o�� --- <br /> Describe ProPosed Work G/'a c�i.�� �i' 7��i.= cC n��.-o�'�-ir.�y' of�i�ig <br /> � , o --- —_ <br /> eX� c7�c�fcn�on �'n�+c�ctnu�in.t'YeCLo�ni� o� /7zCtt'cn rl J'ei��«c' <br /> / ,�y � - <br /> lt,'l�7�P/' C7�/I'CYJil��7 0/7�C�E�J ?�s� i i.s �O lOn�iyr� /Y�i0/T ?/�O� ��eC_7� /� <br /> /�!$� f'/�c vi ✓P�-r:n,• .6c .•� W <br /> i <br /> Projec�Add�ess(il known) -�003 k�. Cn3.�+o .t'ct. �` �r��9.�Snn/ jn n����T/�f�/'t iNC- LOT � <br /> Altach low(4�copies of pinns for proposed work� Draw lo scale antl note Ihe lollowing as applicabte�. � <br /> • Proparty Lines • Cenlerline ol Street � <br /> • Oulline and dimensions o�all ezisting and • Indicate North <br /> proposed slructures on the lot • Show any proposeA c�radmn chanyes <br /> • Ezisting and proposed ulilities • Show measuraments . � <br /> DO NOT WRITE BELOW THIS LINE <br /> PERMITCONDITIONS � , , ., �,1, �� � O <br /> 1.All calis Im Inspection shell be mede 24 hrs.in edvance-phone�S9•88�Q - � �� � <br /> 2.All work shall be performed in acwrdance with ihis permit nnd curren�City of Everett Dosign and ConsVuction <br /> Stenderds end Specifications. <br /> 3.Cell Locetlon Undarground Service 4B hrs.belore you dig.TOLL FREE NUMBER 1•800•424•855b. � � <br /> 7 �`!iS ���'I����� ��LS rlt,� /nl'�c.i�� rl nf/�i-nc�isg 7���' f�it <br /> �nhsti�vcf.e��� O{ f�iP �[�n��..., lc�y S/i-t�� f..r� iff�-/� nr O <br /> qn�/ CtJOr,f [tiif�in f�ic I.J.G/!. f.� C'.'v�i�ic/�.i- � JT'C���� �>r-, <br /> c7�'�Cn�in.-� .�4_ti., OCC�JJ o-�/� � <br /> � 1/1���� � 7ZiJCC� 2 �Oriy �iir' �!C!'!�� ��rS lc ��.f:��ri7 �'�t nU�qi,y' � <br /> �! ./ ✓ O <br /> (J� /.1�� Gt/i�t'Ci�C �'Oh/`i c�oi� 4nc��7�0.,y �fIC /70rJ��zrh /fo(/i��r- <br /> !'� /./jC „+ �� � ' A <br /> O� fCn�il�4�Oioc�(.�C�r�. 7-��CYnJ /aoUJ�7�6e /�SP�?ffPt� �I <br /> �j/ �f/G 67�/ �I'i0^ � /nifia�il7h �c'nl+SiOi� C�O/�fr0 � l✓pi`.E. <br /> �� C3/r![�•�� /q Vc'�/i+ �iCin �k/�C�Oi'CN /9/!/J� l'P �C�ioc' <br /> ��/� C" /s�� `7/C�i, ����mvtt/ O� SZ�9Y� ACKNOWLEDGEMEMTOFCONDITIONS <br /> �CU�?✓ Of�n����> The undersigned ownor/npptrcant hereby xgrer�to hold and save harm� <br /> � less the Ctly ol Everelt Irom eny and ell claims lor damagr.s cosl.. <br /> � � expenses, or causes ol ection Ihal may arise hecause ol inslallatlr��� <br /> � .._�` —�_ J y �� nnd mnintennnr,e o� the improvement or o0ier nqhPobwey use here•o <br /> � � applicd lor end �urther agrees lo remove s�me upnn nolice Irom Ihr <br /> A piov jGr ConsiryW � Da�e Cily and b replace public property damaged Ihereby. <br /> > I <br /> />i i , � � .��"'v-vy�-!/ �2//!Z' <br /> kI1TJAL INSPEC����T�— � � <br /> Approvetl ns Cons�ruCted Su�nature ol Applic�n Date <br /> � / PUBUC WORKS DEPARTMENT WORI� AUTHORIZED BY THIS PERMIT MUST 8E STAf7iED WITHIN <br /> � 3200CetlerS�reet 18U DAVS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everpit,WA9B201 8[ DILIGEN7LV PURSUED TO COMPLETION. iHIS PFfiMIT MAV BE <br /> PhonP 259�BR10 CANCELLFD BY THE CITV UPON ANV SiOPPAGE OF WOPK C1N ilUS <br /> PRO,If GT OVLR 9p D�VS DURATION <br />