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oa�e��C y y rn p4�ING '1 �"��' ��,�,.�, ,.,�,�=P�,m,,. .�� z�� <br /> umn o�w • . -- - <br /> Applir.alion For � <br /> PUBLlC WORKS PERM �T `'�°',o,a�rt�`°° s <br /> Sless anui Fcr va�.:f 5 _— <br /> gS Baianrr Dne S �C� <br /> Print or Type Only z <br /> 'g..' N � 002 -�2Z'f�/ 783/ <br /> M N <br /> ' J/ 1�____���. �����_��av�a 9'R o 3 '3 3 7—'7� � <br /> , , � <br /> O� ai , \`a�•ir.. :ii:i]e•y5 \[.� pp� : . LP Phonc <br /> C+l OHJ <br /> ���- ------- - - -�—���- ------ - <br /> Apphcant � C.nh��,;.1rt�ll�•ss C�N ZiP Phonn <br /> Descri6e Proposed Work _Ll�.L' ��^L--,/�--/�� �_�1-��-�-'�—�—_��������' ��.! l- <br /> — '—__ -__-___'__. ' ___... '___"_' ___'—_ <br /> ._'____ '_ _ _ . _ "._—. _ . "_--—_ /' -- � <br /> ProleGt AAdrecs lif known` ..l(J�V-J�.�.�._. -_���.���11�C �/_^r_C=��.��_ � <br /> Attach Icw 1�11 coPms ot Plans Ini P�oPosed wo�n- Oiac. io -�,i'., .r��:� nG.r thr !o�la:nnq as aPUhcahl� �� <br /> • ProPe�iy Lines • Cent�'ilinn n�5�re41 ,A <br /> • Oulhne ai�d dimensions o� all exnhng anA • Irdicatc Nonh V� <br /> propo5etl SIruC�ures on�he io� • F��ow Any rro�osed qr�rl�nn chan.irs <br /> • [ri5iing and P�oPoSed u�ilitiCs • Shnw m��a.;uu�mrnts M <br /> W <br /> DO NOT VJFITE 6CL061' iHIS LWE O <br /> PEHMIT CONDITIONS <br /> i.All calls for inspeclion shall be made 24 hrs.in advance-phone 2$9•8810. � <br /> 2 All work shall be pertormed in accordance with this permit and curtent City ol Everetl Design and Conslruction <br /> Standards and Specilications. <br /> � 3.Call Location Underground Service 48 hrs.belore yoo dig.TOLL FREE NUMBER 1-800•424•5555. � <br /> � � •- <br /> /�s ��c��,ii� is �r mav..,y n:i-f onlY. A.�fi i»orc O , <br /> �p,�elo�ome�7` O� �oY� /0 S/ialL r�qUirc an <br /> Qo��f nna ` Pe?�rni f � � <br /> N <br /> O <br /> a <br /> ACKNOWLE�GPMENT OF CONDITIONS <br /> Th„u�,A�.rsianetl owne�inPPhcant herebY a9rees to hold and sa�-e hann� <br /> —�--- � - -�--� les; Ihe City o� Evarelt lrom any and �II c:aims Inr dama9ea crosls <br /> •, i�xpenses. o� causes 01 aclion ihat moy ar 'e cause of installa�ion <br /> / .and mamtenanr.e M Ine improvrment or e< <ig �-ol�way usc hereto <br /> / YJ Z��. ! a:-pi�.nr: fsr and turin��.r anrees to iemo e . ne u on notice hom the <br /> Approved for n Ir ion -- .ale ' C '� u�.:f In i�•plac�• nublic ProP••�ty dame ed �r y. <br /> / / � <br /> � / � <br /> I � v <br /> FIN I F.CTION �� ���0 I � - Daie <br /> Approved as Constructed i Si9natwe oi AnPhcan! <br /> � � \�'OFY. �1UiHORIZFD BY THIS PERMIT MUST BE STARTED WITHIN <br /> ,�Ii�./ PUBLICWORKSDEPARTMENT I t80 DHVS GF DATE PER�dIT IS ISSUED AND THEREAFTER IS TO <br /> 3200Cedar Sireet BE DILIGENiLI' PURSUED TO CUh1PLE710N. THIS PERMIT MAY BE <br /> cveretl,WA 98201 I CA�JCELLED B'f 7 HF CITY UPON ANY STOPPAGE OF WORK ON THIS\� <br /> Phone:259-8810 � PRQi[Ci OV[R 90 DAYS DURP.TION. . <br />