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�� <br /> � �� , <br /> H <br /> Cy� H , - <br /> I-1 y a'L' -7 ��i�� '.��_ r,�niicwo�waermn. %v� C. �/C. <br /> K�n Dete.C___�_L.� a�aa 000�.. — . <br /> H %t1 Appliwlion For <br /> '�� H���------111 PUBLIC WORKS PERMIT °°""`"°'"„`° S -- <br /> Tolal Fe< <br /> ��� Les.Pppl FaP Po�d � � <br /> ��7 �,i,.x:cour 5 ?n�` <br /> G <br /> �� � Print or Type Only ` <br /> �� 't"�'- i.'<'S'C��-•_t/ <br /> 47� c] 4 '?" � <br /> �y� � Or. S F, Ev�-rE�T <br /> °,'CI,tJ� �C.. 1�6�C,A`.9���Di l.�"� ' Z�o Phone <br /> H y �w��y hlailin9 Atldress ���Y <br /> gy � i <br /> tyv, I�DD�I�i/ �'N r'�oinrs Pd b�r /c� 3:? ��ini����a/ Y40y6 9C� 3967 <br /> ��� AppLcant MaJiny Address City LP Phone <br /> ypvi l�p � CUV'�a CV� � I �tc+ �'�hc �' ou* �'1 Far <br /> De,s,1criUe Proposed Worh V <br /> c.INiVc ���J Cc � �— <br /> G:��.� W <br /> Proiect Adtlress(if knawn) ^��` 1 � �r S ��e Y C"�t � <br /> � <br /> Allach lour(4)copies M Plans lor proposetl work-Oraw to scale,nd nole Ihe�ollowing as apphcable: � <br /> • Property Lmes • Centerline ol slreet <br /> • Outline and dimensiuns ol au ewsting ancf • Indicate Noith <br /> proposetl strudures on thc lot • Show any proposed gradin9 chanpes � <br /> • Gxistina und proposed utiLbes • Show measuremenis /� <br /> W <br /> %.-� - DO NOT WRITE BELOW THIS LINE O 'I <br /> � C� PERMITCONDITIONS � <br /> 1.All calls lor inspection shall be made 24 hrs.in advance-phone 259•8810. , <br /> l , 2.All�wrk shall be pertormed in accordance wilh ttis permit and current Cily ot Everetl Design and Construction <br /> Standards and Specifications. � <br /> , '��I 3.Call Location Undergmuntl Servir.e 4B hrs.belore you tlig.TOLL FREE NUMBER 1•800•424•5555. 'I <br /> i ��► I <br /> `� �C[L✓ <cc7� �'kIS�Yh4 .;�c�_ [,..., L�C r.c � � ) '�.�� .i-1 S<�.�1 � � �'� <br /> L J � <br /> �/i4�'l� C1Y 1'i :N7C✓•7 �G �X��c/ r�1.C.� JO�I'f ' /,'(CmG/✓<' f��r� <br /> i �� (�Y.��)��'fc�� Qr.�C� /'c�7..:�%i- _ UP i-.Cr �i�C(,�" O�1 [�:�i'O. �w I <br /> � l !i �� �'/ // ,-/����JC�1 Q;,'7i:i/".'� �� /.'%. i <, c li ;i I ( ' �/ 'i <br /> !1��1 � I <br /> a � <br /> ��_� I <br /> � <br /> j nCKNO\VL[DGEMENT OF CONDITIONS ' <br /> ������..� �.Olu Tlmundeisi{{nedowner;aPPlicanitierCUYa9rees�oholdantlsavehainr <br /> �' <br /> �� less IM1� CiP; ot Everett trom any and all claims lor damages, cosls. <br /> exPenses. or causes of nclion thal may anse necause o� insla alion <br /> � !/ /�'� G' and mamtenance of thc improvemenl or olhc� ri9ht�ol�way use hereto I <br /> �/- �.✓'CrY�-'- apUlicd �or and luriher a9rees to remove same upon notice irom Ihe <br /> Approved br Cons�ruf ' / ���� Ci�y and�o repl;ite Pu61ic nroperry damageA ihereUy. I <br /> i� <br /> � ,��-'� � 7-,7�- 7L <br /> �� �i%, , <br /> FINAL INSPECTION �°'�� Date <br /> Gpproved as ConstructeA �i9��alwe ol ApPlicant <br /> �7Pl18LICWORKSDEPARTMENT WORK FUTHORIZED BY THIS PERMIT A1UST BE STARTED WITHIN <br /> 'V� 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO I <br /> 3200Cedar Sirect 6[ DILIG[N1LY PURSUEO TO COMPLETION. 7H�S pERMIT MAY BE <br /> EverelL lVAJ8201 p1NCCLLLD OV THE CITY UPON ANY STOPPAGE OF WOPK ON TNIS <br /> Phonc�.250-9p10 P170J[CI OVCR 90 D,AVS DURATION. <br /> _. ..'_ '"._ __-. � <br />