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�� <br /> -,��_� � �„�,�.�H�„=P�, �_� n4_�_ <br /> D.11@_L-L_�� �•� qien oeoi • <br /> qpplication For __ <br /> pUEL�C V���RKS PERMIT �°����`"�, `8 g— _ <br /> totai <br /> F3 C�H �res �.re�ram 5 — <br /> T F"' '+tl <br /> Cs] ts] o. o000 5� <br /> 9H -- <br /> q � H Print or Type Only <br /> � HCn <br /> y ��'�'' j`'1�ii k I��C,rL�lk3it %�ltCl Ll �l��i�l A�� �t'trttL \ � `IC � ��Q�-35f`; �vi. -- <br /> Phonc <br /> 050 Owner Mailing Atl ress C'ty Z'p <br /> � yH _— <br /> S O� Mailin9 Adtlress Gly Zip Phone <br /> ��� APPGcan� <br /> H C7 <br /> �y L�T1C.Wl: ��L�'i :'''lll.� ���" �L {.\'�Cl', { �OI"�l �.'ca1'i'� �GC.. <br /> � [�i) p Jescnbe Proposed W�rk <br /> �V [] <br /> H � <br /> � N W <br /> H <br /> > H y — <br /> r <br /> �ti ` <br /> d � Pwi��t lddress 1�1 known) � c�'� '��'�r1 � �b�.'f 1UL_ �— <br /> �� " - <br /> [*J AitaG��our W)copies ol plans for proposea work�Omw lo scale ar.�note Ihe lollowing as applicab����. � <br /> • Propeny Lines • Cenlerline of strect <br /> y p � • Indic:+te North <br /> • Outline and dimensions of all exisLn9 arA � Show any propo5ed gradin9 r.hanycs <br /> � ProPased slructures on Ihe lot • Show m..25urements � <br /> • Exisiinn and preposed utililics <br /> � DO T IVRITE BELOW 7H15 UNE [f\) <br /> i V <br /> � _ PERMITCONDITIONS ^ <br /> 1 � t.All calls for inspec�ion shall 6e matl hrs.in advance-ph0�e ZS9�88�0. <br /> `� 2.All work shall he pedormed in acc ance wilh�his permd and current Ciry o�E�e�ru Des�g�i and Consiruclion ♦ <br /> Standartls 2nd Specilications. � <br /> 3.Call Location Undergrountl Se .e 4B hrs.belore)'ou dig.TOLL FREE t1UMBER 1•S00•424•Ci555. <br /> i <br /> �. �Y�S"�a�� e5'�'i�Or ,ti�l"�k��J� ��� ��i�C�C �CC� �' �'��bIfL �VOrK5Ir1h�)Co�'1. O <br /> I o� <br /> �w�_� � <br /> i <br /> `� i r � � �c�.��°I' � <br /> / ; � Wu <br /> i.�i1cF � �l�rN�� � <br /> ���� -�.,r L �,. I 0�(�':. � <br /> 7�� <br /> �1� .1C��WOItiLEDG[41LIJT OF CONDITIONS <br /> � _ __ The unCcis�gnetl owner/upphcant herel�y aqrccs to hold and savc h;�rm- <br /> � -- less Ihe Cdy ot Everett ��om any and all claims for damayes. cads. <br /> expenses. or causes oi aclion ihat may anse hecau.e of installatio�� <br /> ���� q i� and mainlenance ol lhe improvemenl or othrr right�ol�way use horeto <br /> . I �,E� I�I�� applietl lor antl �urlher agrees Io remove same upon notice from the <br /> ,�pproved 1or Conslruction ���� Ciry and lo rep�ac�aublic p�eperty da:.�a9eA thereby. <br /> Q --� / <br /> F,�� n' <br /> /`//�n�Ci '4 �7 —f�� / > <br /> RN,1L INSPECTION �''�" � Da�e <br /> Sig ialu�e ol Apphcant <br /> qpp�nvCA d5 CanSiruCtEd <br /> WOFK AUTHORIZED BV THIS PERMIT h1UST BE STARTED WITIII <br /> �— PUBLICN�ORKS�EPARTMENT 180 DAY� OF D".TE PFRMIT IS ISSU[D PND THEREAFTER IS TO <br /> 3200 Cetlar Sircc� BE OILIG[NTL" PURSUED TO C0�IPLETION. THIS PERMIT tdAY BG <br /> �+� [vercli,AYA 98201 CANCELLED E�1HC CIT�UPO�J ANY STOPPAGE OF N.'ORK ON THIS <br /> fhone 25D�A810 � PROJ[Ci OVEI,JO DA���DU�r1TION. <br />