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_ . _- -----� ---- <br /> - - - - --- - - --- - <br /> _ .•� <br /> ,.,,�,���w�,,,,��,,,m,� <br /> Date�����1'��0 ._ r+ma oNn� . _ ,9,.> -�` 77O - <br /> nun����uan r'oi _ <br /> PUBLI�; WORKS ?ERMIT "°":o�;<«�`° s — <br /> less Anul 1"eo Paia 5— <br /> paianceDuc � <br /> Print or Type Only <br /> Y 1G1 lCx �.J � � t' ;��I ,(' C' 4 �G � l +��( t CI � ' '' C l� �,'1 <br /> Owne� // y <br /> Mailin�AAdress Ctly Zip Phone <br /> r / � . � ��� ��Ii t �'.� f �.1~Q L �_//C �-'��/" ���(J!' <br /> .� l f �l �i't ,�� :' � L /" �� 5! T' <br /> qppllcant <br /> Mallinc�Address City Zip Phone <br /> Descnbe P�oposrd Woik <br /> ��C.( �C.� � — — <br /> W <br /> �/ �-�' F- <br /> — :'7 ,:% � -��W --- <br /> Pro�ect Add�ess Id knownl <br /> 9.l5 aPPPCabIC'. � <br /> Attach lom 141�opies of plans tor proposed worh� Diaw to scale and note the lollowin � <br /> • Property Lmes • Centcrline ol sireet <br /> • Outline and Aimensions of all existiny and • Indicate North <br /> � ptoposed slrucWres on Ihe�ot • Show any proposed gradm<�ch2nyes <br /> • E�isling antl propnsed utdiiies • Show measuremenls M <br /> W <br /> DO NOT WRITE BELOW THIS LIN[ � <br /> PERMIT CONDITIONS � <br /> 1.All cails lor inspection shall be made 24 hrs.in advance-phone 259•8810. <br /> 2.All work shall be performed in accordance with this permit and wrrent City ol Evew_��Design and Consiruction <br /> StandarAs ond Specifications. � <br /> 3.Call Location Underground Service 48 hrs.Uelo�e you dig.TOLL FREE NUMBER 1-800•424-555b. <br /> O <br /> � / � ` :( � <br /> �' � �f� f - � . , './;; ,�r�t,_U.: r� <br /> GiC�C �: (v'E ..- . Y/ <br /> ��"�� � Q <br /> ,- .,�-;, a.r <br /> ACKNOWLLUGGIdENT OP CONDITIONS <br /> The undersqned owner/aPPlir.anl herel�y a9rees to hold and save harnr <br /> __-- — less Ihe Cdy ol Everet� from any and all claims lor damagi's, costs. <br /> ezpenses. or causes ol aclion Ihat may a��se because of installation <br /> and maiMenance ol Ihe improvemenl o� other ri�hl-of�way use here�o <br /> applieA for and lurther agrees to remove same upon notice twm Ihe <br /> Approved for Constructlon � r Date CitY i��d lo replace n���li:Properry damaged IhereUY. <br /> FlNAL INSPECTION Uale Date <br /> Approved as Constructed 5�9��a�ure of Apphtant <br /> WORK AUTHORIZED BY THIS PERMIT MUST BE �TARTED WITHIN <br /> �i �.,. . ;� PUBLIC WORKS DEPARTMENT 180 DAYS OF GATE PERMIT IS ISSUED AND TIIEREAFTEF IS TO <br /> j � 3200Cedar Street BE DILIGENTLY PURSUED TO COMPL[TION. THIS r'ERMIT MAY BE <br /> I E�Qi, �t,WA 98201 CANCELLED RY THE CITY UPON ANY STOPPAGE O"WORK ON THIS <br /> I <br /> phon, 2b9�9810 PROJECT OVEfi 90 D�VS DURATION. <br /> L <br />