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D�ICl�7,1A / r�m�cwo�MSFa�nmn�r, 9� � <br /> Apolic:ilion For emq oeo' •.�L�L.�lpa�—��'— <br /> Pl1BLIC WORKS PERMiT °°°io;;Fo<�°a s <br /> �t''7 Leea PODt Feo PaiO S - . <br /> .azy PrintorTypeOnly TO POSTIi�G__ z G r� a"'"«o�o s ZO� <br /> 9 H C~/, <br /> rz <br /> H as <br /> � z� ��i" c.� I)r� ��C i�o .� , 2n F_ ,;a./tf �.�zl1'6 33�% S�;i2' <br /> y�7 Ow er MailingAddress City Zip Phone <br /> �J H`+7 <br /> HNC <br /> h O� anPlicant MailinpAddress City Zip Phone <br /> O H d �/1 �1 3� v <br /> � �g Describe Proposed Work _�.,� ��� �P J�{r�+ 'l� ��'1� LfL1�/�� 4"�, <br /> �� � <br /> H � <br /> zH <br /> ay - <br /> rHy w <br /> � y~ 7��:� � - -7` J � ��cS1�L ��p�r-h{-C!� � <br /> O C7� Proiect Address(il knownl <br /> � �� AliaCh l0ur�4)copie5 0�p�ans lOr proPo5e0 work- Dr�w IO scal��ntl note Ihe�nllowin�a5 apPl¢ahle �o <br /> � H�� • Prooerry Lines • Centedme ol sirecl � <br /> • Outlme and tlimcns�ons ol nll cabim{{:mtl • Indicalu Norih <br /> pmPosed strur,iwrs on ihr Ipl • Shon any preCosecl yradlny chan]e'.5 <br /> O [ris'Lng:;ntl i;ropa:.�,C uldibr� • Sho:v mrasuremenis � <br /> DO NOT 1VRITE BEIOW TH'S L W[ U�/�U%'Y. - ,-�m UUL'.�:t�,��_ <br /> FEFt.11T CONCITIONS '�:�:?` <br /> O <br /> 1 qq calls(nr in�pc::t�on,hall b,t insde 24 hrs in advdncc�phonc 2SJ•$E�C. � � � � <br /> '....�, 1.All work shail be peAormed�n ac[ordance with ih�s permit anA_�urent Qty o�Everen�c �Jrl��d CansGi �Ion;�� <br /> � Standartls and Specilicatlons. � <br /> 1� 3.Call Location Untlerground Service 48 hrs 6etore you di9.TOLL FREE NUMBEH 1•800-dZ�l{•55551SJ.!'0 � <br /> F `-'�CH 5�+,`-0 <br /> (���' DFPJW'.' t�U.C:,� <br /> �a .�, 1100007�41 � <br /> WRTER 41'�t�.C�i <br /> aoaoze�7s <br /> I` �j sEut� R-o.; , �"� <br /> _-.. ,,,,, �/� <br /> , ,..,. ` . � \P� <br /> ,. �^ <br /> 6.1. <br /> � ,, a <br /> !.CltNOWLEDGE�dENT OF CUNOITIONS <br /> � � <br /> � � The imdersi9netl owneV pplicant hereby a9rees lo holA and save harm- <br /> ' �-- Iess Ihe GIy ol Everett irom c�.y anA all claims lor damages. cosls. <br /> �xpenr,es, or c:wses ol actior. ih;tl may anse because of installation <br /> �_ p �L�� � �_�I and maintenance ol Ihe improvement or other nqht-ol-way use berclo <br /> _ UK� ipplied lor anA lu�ihcr agrCes to remove same upon nolir.e Irom ihe <br /> `.purovr.d lor Constr tion D;�le <br /> � City ind W replace puUlic pwperiy damaged�hrreby, <br /> if"/.'%%� /�-ii � //���^ ;� —�,� � :�V - j� <br /> RNSL IN�PECTION Date �'�^'� <br /> Ap,^.rnved as Constr�ded Si9r., we ol App 'ant Date <br /> fi–' PUBLICWORKSDEPARTMENT WORK AUTHORIZED BV THIS PERh11T MUST BE STARTED WITHIN <br /> �y 3200CedarStreet iN0 �AVS OF DATB PERMIT IS iSSUED AND THEHEAFTER IS TO <br /> qrFrr Everc0.WA�es01 B[ DILIGENTLV PURSUED TO COMPLETION. THIS PERAIIT MAY B[ <br /> P , L e' a CANC[I.LED�Y lHE CITY UPON ANV STOPPACE OF WORK OIV THIS <br /> PFu)Jl�t:i p1'I N fl0 DAYS D119�1TION <br />