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.�i n � <br />t� .`J' r`i'. <br />C H <br />9 y Cn <br />rx <br />ri a 3 <br />y�H <br />�H� <br />O SO <br />'�] H 'i1 <br />�M <br />�O� <br />H C7 <br />Q H <br />H C7 O <br />4] • C) <br />9H� <br />r z <br />HH <br />p�H <br />n d� <br />� � Csl <br />30f�i� <br />f_ il�� <br />,w � <br />f� .es <br />� � <br />i 6'i <br />Date�atic:Ls��� <br />� <br />AUPlication For <br />PUBLIC WORKS PERMIT <br />Print or Type O�ly <br />� <br />( �o�c� <br />Ovmer <br />\ <br />•. h+ i <br />Applicant <br />o�,�s <br />Mailing qddress <br />Ma� ing Atldress <br />3 c� <br />C�ry <br />Ci�y <br />Describe Proposed Work �� 1�� G�'� �''<J � y <br />Proiect AAdress lil knownl /�,����� — <br />Cubl¢1VodaPorm �� � �" �/ <br />C <br />Bmq. oeoi • �� ? �� � . <br />auonc works � m —. <br />Ta�a� ��e s --_ <br />LessAOP�� Feo P.��L � <br />?� n.� <br />Ba1an<e �ue S — <br />f��Z �i �rL�,> C� r' ��,', j/Y� <br />� Phpnc <br />�fnmh bw 14) cOpieS ol plans lor pmposeA wOrk - Draw to 5c.ale antl note the lollowmg as :�pnl,,.ablo- <br />• ProFerry Lines • Contedine ol str�ret <br />• Outline and dimensions ot alt existv�:.�.nd • Indicate Norlh <br />proposed 51rueWres on Ihe im • Show any n�oPoso�1 qradmq changes <br />• Existing and proposed uUld�es • tihow mc-a� dr��n:nnP; <br />Pi�ene <br />UU NUI WMIIC tltWW TFIIS LINE <br />PERMIT CONDITIONS <br />t. All calls lor mspechon sr»u t:�� :�:.�d�� ��: n�s in ativance - phone 259-881 5 <br />2. All wOrk 5hall 6e perlo�med in r�ccordnnce with thi6 pClmit antl cu�tent Gty nl Ecriutl Desr�n nnd Gonstruchon <br />Smndards and Specil�wtion,. <br />3. Call Locatian Undergrountl Service 48 hrs bebre you diy. TOLL FREE NUMBER 1•800•424•5555. <br />T .���'�/l".5'/✓T /S Tp Sc.G.,,.T .<'r ,_ �. ,' <br />���- �CG%/ / i r_:L <br />� %f�. S L r'li /S %c% .Br Gd�.9UE!> .Sa �iS .LIOT %d 1 ir: �.-''. �T <br />Ti✓E Su.c'.toc/n/U.i7/G- GoTJ �.tiL;.f .F�i�.,✓t✓AiE�C' .f'v�d/,>. <br />�. .��F- T�P IJ�i�.vS/�i��;>J' iS 3'v � -- <br />6E �'�y.✓c �rFa _, <br />/�/E �.f� � .G Gh=.U..,✓Ftn`�' SJ/S� Fi,-�. <br />7 E — — <br />K,s„z% v,��,�,�.v,�y ,s ,� <br />��1 i 7�X�S�,,,� .`."Ef'LF,�lEO c��.-.:� r�.« ��.. <br />r v p�� nlN'EccJ /,.c?.�r�Et��A/ 1S 7u f-E <br />7 2� „Ju" -, ., , <br />�i 1 n`�ri3 �ii �srA,,;o,�,�:v � ;;�., <br />� <br />� �: <br />—/ liL�'ls�l /�.�f'�'f � J'/O/r�L <br />npn�oved for onstiuc n Date <br />���f <br />��� � � ��' % ��J � �� <br />FINAL INSPECTION � 7� Date <br />ApP�roved as Canstructod ��-- //C�� �� ��� <br />i•�.�•i��❑ PUBLIC WOFKS DEPARTMF.NT <br />� J200 Cedar Street <br />Lvcre�l. WA 98201 <br />Phane'259-8815 <br />■:� <br />Ll <br />/� <br />� <br />O <br />Bce ra.rEti� odr 9^-, �� L_ <br />�`.�T C(/,�G' � �vl7E4 , <br />S�/s7yCl� !n r�� :� c iT/ <br />ACKNOWLEDGEMENT OF CONDITIONS <br />Tho undersigned owneUopPllcant hereby ag�ees W hoLl .uid sa��c h;irnr <br />Iess Ihe Cily ol Everett Imm �ny and all claims lor dama9es, c-ost:;. <br />expen5C5, or causes ol action Ihal mny arise beCause ol in5�allation <br />and mamtenance ol ihe improvement or olher right-ol�way use hereto <br />an ��d lor anA lurihe� a,� ees to remove same upon notiCe Irom thc <br />Ci y a d to replace puUlic property tlfimac�ed Ihereby. <br />�.1:_l� � U'ti`-l' -�— � 2 v S" ,6 <br />Siynature of ApPlicant Dile <br />WORK AUTHORIZED BY THIS PEFMIT MUST BE STNRTED WITHIN <br />180 DAYS OF DATE PEFAIIT IS ISSUED ANO THERE�fTER IS T� <br />�E DILIGENTLY PURSUED TO CilA1Pl.1[TION. THIS PfRtd1T A1AV BL' <br />CANCELLED BV THE CITY UPON �WY STOPPAG[ OFYJOf;K ON TIIIS <br />�'�i4JFCT OVfR 90 Or1YS DURrtlll�l�. <br />