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� L` � <br />� <br />H <br />7 H f~n <br />� � <br />� H � <br />O 61 O <br />�V H h1 <br />y M�+ <br />S x 3 <br />� H O <br />� � nC <br />z H W <br />� M H <br />(�q] O N <br />[9 � IrTJ <br />Z H [n <br />H O N <br />I�� <br />s <br />d �a 1 <br />D ate_— <br />ppplica�ion �of <br />pV��.�C WORMS PERMIT <br />Print or Type Only <br />,. � <br />Pu111iL Ylo1h5 PP=_Til � ��� <br />/'\ <br />�/. <br />Bme ocot , ilf <br />rw�i�� wons r�w S <br />ro,�� F��. <br />Less aoo�. F��• Pa'� 5 <br />n.�i.inreoue S <br />n ( .� II<<k� ,,,,t i��.� �)��'�r� ��9•h/��l•���j <br />/ Il �/r1 i. (�: n �;;,:i-I 1 N�I i�lt ' CIIY �L�p <br />J-����� I1 � � � Maihnq Address <br />Owner <br />, . ; �, �-;i;����� - i7�2��� ��� ��i-x��� � <br />� � �a , i �i,�_ Z 3i�1 <br />C S ZiP Phone <br />_ �t' �. � � �ti � " Mailin9 Address <br />qpplic�nt <br />Describe Proposed VJork <br />Proiect Address lit known� r`_.�---�-b^ `—='-''"'- � �� / <br />At�acn four 1�11 cou�es of plans for Prnposed weih - Draw to sr.ale and no�e O Ce�nl�er ne ol s r�eEt able�. <br />• Properry L�nas • Indir.ate Nor�h <br />• Outline an.i tl�.mensions o� all exisGm;, and � Show any proposed 9rad���9 �h�n9es <br />praposed s�ructures on ihc lo� �$IIOW �»P�SUft'fI1Cf1�5 <br />7 Existing and proposed utili�ics , <br />— pp NpT WRITE BELON' THIS LWE <br />PERM.T GONDITIONS <br />t. All cal!s for inspeclion shall Ue made 24 hrs. in advance- phone 259•88 <br />2. AI', work shall be pedorn�,ed in accmdanca with this permii and current Ciry of Everelt Design and Construction <br />Slandards and Specitications. <br />3. Call Location Under�round Service 48 hr,. before you dig. TOLL FREE NUMBER 1•800•424•555 . <br />�� <br />L� i � :i:";�,i' _ <br />/ rJ/,;:x%`c - � , <br />Constiuclion <br />� <br />..�` . . ,- . . ��;,.. , . -f <br />�, � <br />Date <br />l"'�.� 1.�� ... �: �. <br />i� <br />, <br />;�%_�;� _,� <br />� <br />� <br />• <br />r <br />ACKNOWLEDGGtd[NT OF COND�T�nNS <br />The undersiqned ownedapphcanl hereUy a9�ees to holA anA save harm� <br />less the City ot Everett Irom any and all claims lur damages. costs. <br />expenses. or causes ot action Ihal may arise Uec�use of installatio�� <br />and main�enanu� �� �he improvement or o�her ngh�-of-way use hereln <br />Ciry�y�A�to epace�publ c��proper�Y�da �aged �ereby.n notice 1rom �he <br />Date � �—�-- Date ' <br />FINAL WSPECTION Signa�mc ol Applicant <br />qpprow=.d asConstructed WpRK �UTHGRIZED BY THIS PERM�T MUST BE STARTED WIiNIN j <br />PUBLICWORKSDEPARTMENT 18� DAYS OF DATE PERMIT IS ISSUED AND THEFEAFTER IS T� <br />evereu BE UI_IGENTLY PUPSUED TO COMPLETION. THIS PERMIT MAV BE I <br />O 9200 Cedar SirPel ...__ . . . _ _—_'_ � <br />E'ieretl, W� 9g?0� CaNCL.LLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS 1 <br />"hone: z59��R10 PROJ6';T GVC-R 90 DAYS DURATION. . <br />