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/ <br /> i�) 7/. r„�„�_c c:.,�.s o��„n �1398_ <br /> D31r�- ' �J- '—`� 5"77�/G <br /> r�ao oro� • � <br /> Aophcalion For � _ <br /> PUBLIC `iVORKS PERMIT '°"°`""°'",�Ce <br /> ro�a���r $ <br /> Cy�TJC�r'7� �nsnooiroev,:�a5 -. <br /> a H � c.:���o o�e 5 zo -- <br /> C�F., Print or Type Only <br /> 9�-3[/� <br /> i~-3 Z r�i �,�� , i� �- ,� -� " v 4 , Z S'�/— �.i�G <br /> K C] /+ G--.. Zip Phone <br /> y'b I Owner Madin9 Addiess ���Y �; <br /> "�� H� <br /> f/]H ////�� ��,� � �� <br /> Eyy Z 3 —�r'�'-"" Maihn�Address C�Iy LP Phone � <br /> APPI1w�it �j�� ,. <br /> y0 <br /> � �p Describe Pro�:.s�d Work �r " � �f�" <br /> L�• O — <br /> 9 H� <br /> r �'� C �U S ' Z- N D L"7fL `..�C _ � <br /> ~ �� 3f �'�-��Ls -.F' � � <br /> ge�, ,�.�� �_— — ---- <br /> � � Prolect AAdress lil knownl <br /> 3 C <br /> z �� q�tn-,h low �. , cop�es ot plans lo�DwPosetl wo'k�D�a�•: i i'���!i�+��ntl rolc Ihc lollow�ng as apnLca4�,. � <br /> y �� o Pioperty Lincs • Centerhne ol street <br /> • Outhne and dimenso�s oi all r.�.•.tinq,:��tl • Intli[nie Nor1h <br /> U�oPOSCtl SlruClures nn iLr Icl • ShOw 0ny prOPOSed q�t:�'i,nl CPanqo� <br /> • Enis�ing and P�oPosoA utditi�... O Sh,O�a ma:�smrmCn�s � <br /> DO fJ01 1VHRF f3ELOl1' lHIS l_INE � <br /> PERMIT CONDCIOtdS 259•g8�0 � <br /> 1-AIIeallsforinsPeclionsh.�ilhemade24his.mativance nn��"' ntC;:��' '.����^.� ��,.�,��i�'•+�+nCenshuction <br /> "� � 2.NI work shall be peAormetl m acwrdance wdh this per.nrt antl wur�' � '. - <br /> '� Standards antl SPecdicat�ons. <br /> 3,Call Localion Undergreund Scrvice 40 hrs.belore you tli9 TOLL FREE NUMOER 1-800-424-5555. �i1 <br /> fr <br /> ��! xV�� . ` <br /> � "` 4.ANY CHANGE IN TFf� DRIVLWAY CUT t10ST Bfi APPF�iV}?�� � <br /> 8Y 'I'H6 PURI�IC WORKS 7NSPECTOR. � <br /> ""s 5.CONNF.CT IXJWN:�POU'I'S TO PUBT,IC DRAINAGE SYS'PEM. <br /> i� 6.KEF.P CITY STREF.1'S CLEQN AT A1,L TIMES. 'q <br /> 7.ANY DAMAGF: TO 'PHE CU) il AND SIDLWALR WILL HE HI;PAI}2F.I'� V� <br /> �,a, 'TO 7'HE SATT�FA�9'1�)N OI+ 'f1�1L' PIIRTIC WORKS DAP'I'. � <br /> �, ,� � <br /> �' �1 <br /> =I�� ACKNOWL[DGGMENT OF CONDITIUNS <br /> �a� `' ��7 The untleraigned owncr/npphcanl he�e6y a9rees to holA and save harm� <br /> � "'� less ihe G�y ol Everett hom any anA all claims lor tlama9es, cosls. <br /> eapenses. ar causes ol aclion Ihal may mise because M installation <br /> and mninlennnr.e ol ihe �mprovemeN or oiher u9ht�obwaV use heie:o <br /> . . ���.t,l.Q_. �L �f.,:eR, g -�'—90 apPlir.d for and furih�r ayrecs to iemove same upon naticc from the <br /> Approvvtl IOr ConslruF�� n 0��� C�ly and to inPlace puULc propeilY damaged�h�reby. <br /> !j' . i` � /^� C. ` <br /> ,�,,/;,",i ���' / _ , I !� <br /> Dalr, Gl'z�'� / �_. <br /> FINAL INSPEGTION Siqnatarr,ol phcant Dale <br /> ,1pn�����1���onstructed <br /> WORK AUTHORIZ[D f3Y 1H15 PEFMIT MUST BE STAR�E[1 lVI7Hitt <br /> „��.�„❑ PUBLICWORKh'DEPARTMENT 180 DAYS OF DATE PERMIT IS ISSUED AND iHEREl.FTC:N i 7�� <br /> �/\ 3200CodvSircc; [3C. DIL1C3[NTl\' PURSUCD TO COMPLGTION 7HI5 PER6111 �t .. <br /> �` � �. .,.n . , ,�. �.� i i i i� ' v t i�C ri n ,nN at � ti1i�Pi°naC Ortvnr.r. r � .. . <br /> i <br />