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o�t� y �rw �3 <br />qpplicalion For <br />PUBLIC V�ORKS <br />Print o' TyPe Onty <br />-�i111d�f.--fl4 LiwoGY Ci�y— <br />�pplicanl Mailiny Address <br />� �+at—_Q V �7 ..5 <br />--y, R ��--�--C.xce_.�.l._� - <br />Describe Propose� Work � _ <br />�3 � �� <br />F'ue��c No�ks Pcrmoa a �,3 / <br />B�ay Dcot � �J�� <br />Pu�lm Wo�ka Fue - �% � ��_ <br />54�'-�-' <br />To,a� �a� _ _ <br />� <br />i�.aaaoiFeeca�og-- �— <br />eaie�ca o�« S �-�� <br />Z'P <br />Zip <br />� r.r � n-s uo [9 DJ�-� d rs W1f `��—� <br />Projecl Address lil knowN 'T�° - � ��-� <br />Atlech four (4) copies ot Plans for proPosed work • Draw to sca'a 3nd n°�� �he �o1lowing as applicable. <br />• CeNedine ol slreet <br />p property Lines • Indir,ate Nofoh osed 9�adiny changes <br />• Outline and dimensions ol aU existiny and � Show any P P <br />proposed structures an the lot � Strow measuremenis <br />O Erisiln9 and ProposeA uti'ities .._...^ .. c <br />PERMI7 CONL'ITIONS I <br />rvr,ret� Design and Cens'iuc�ion <br />� q!! cr�ls �or inspeclion shall he made 24 hrs. in advance - Phone 2Ci9'��� <br />2. ,VI werk shall be Per�ormed in acrordance with lhis permil ana currenl Gi1Y �� <br />Standaids and Specifiwlions. <br />3 �,;; ,.,,,,�P,on Underground Service 48 hrs. bclore you dig. TOLL FREE NUMBER 1•800•424•�'�w •` � 1� <br />/ 1 1 ' y� G �ti '�C�n C �t� � � 't <br />l��, LxtS'T�v� ctf�.iewa— �•> <br />�� �..�-�; e e 7.i �6 -r � �, y �� o �i S-e C� o �� � � e �� 2'C �. . <br />� <br />1 �, ` r Q+ "a G *- <br />Il< a ��.� 1 S Lt t'ir' C v� o�'1 .'F i r c� �� � <br />�Pn . ,,,,.��� «It��vP.9 �� .� <br />W <br />� <br />�9 <br />� <br />f� <br />� <br />F <br />M / <br />� ������ti� � � <br />1 S ' ,� ,,,..* ,�� d r . ,.i C� �.� �r ,� a v. '��, o .... � cl •��-el-- � <br />�e 5 � � ' .��n C �n r'� 4= <br />�- � '� b � � �v� � ^' .; `' `/ti �' . <br />S�k P �- '-'' —1...I- <br />� ,��.,e vu t�ft wu-� x- ��, �i,,.-.. <br />����er . S�..N.��- � n�e �^ I <br />( �,.� � �4A���CKNOWLEDGEMENTOFCJNDITIONS <br />�1l��wnble cl1��VPV� licanlherebyayieestoholdandsa��eharm� <br />/ The undersigned owacr/apP <br />�n{„ ��� less ihe City ol Everett irom any nnd all claims for damages, cosis. <br />� expense�, �� causes of aclion tha� may arise because ot installatio� <br />/ -v70-O apPl ed'tor and lurih`eeagre�sVto remove'san:e9 p�' nol cestromrthc <br />�X .,�� �� Z ublic ProPertl' dama9ed thereby. <br />__L�_-- Date f,iry and to reGlace p <br />F'iNP� R E-C11dN <br />�pp-ovetl 2s Consiructed <br />�' PUBUC WORK <br />r /Cft'II <br />� 3200 Cedar Street <br />[verett, WA 98207 <br />Phona 25°�a015 <br />� l/� � <br />�/ /�-5'-g' i <br />—' ' Date ' Date <br />Si9�� turc ot PpPlicani <br />WORK AUTHORI7.ED B`• THIS PERM MUST �E ST.AFTED WITHIN <br />fMENT � BE DI�LIGEN I Y�PUR UED�TOICOMPLEDTION.DTH �FPFRMIT MAY 8E- <br />C�1NCSl1.ED 8� Tl+c CITY U?ON ANY STOPPAGE OF WORK ON THISt' <br />I'HO.1 =G7 n': �{� `'� JA1'S UUI�AI ION. . <br />0 <br />.~. <br />c'> <br />m <br />=i T� <br />.-. -a <br />� _� <br />� <br />�o <br />mc <br />n <br />O 3 <br />m <br />-� � <br />S —1 <br />fl <br />.o = <br />c <br />� .S-. <br />—i (/ <br />-�c <br />O � <br />T J-. <br />� �i <br />S <br />m �- <br />� <br />0 <br />o- <br />nm <br />�_ �n <br />�� <br />z c- <br />�r <br />v <br />