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Date• � i'�FlS �
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<br /> AopliCn�ion For Gmq oeo� + j
<br /> PUBLIC WQ:F,KS PERMIT ---- '
<br /> �„�,,,�,vo,,,F,.� -----
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<br /> Print or Type Only ,r ::; �: "'�"°"' `^. °° , $
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<br /> 'APPhcan At`,�lur.�Addr�.�ss si_ __+__ ��� /-� l /`! ,�
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<br /> DesCrlbe PrOP/oSod lM1'ork ���-.d-/!�i � ' ' �
<br /> /7/7/^dU46 ' ___ 5�.'.lciJ�.._�/_i✓=__ �Lt� ��,Z r_4
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<br /> Project Address(d knov,�n! � ---'
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<br /> Attaeh lom lal coPies of Plans to� ProPaseJ wor.. . Drav: fo ,�.�:...�,,a n-,t��m,. , n—�O_•L� L H
<br /> ----�_
<br /> • Proper�y Lines �.11O1n9�::lnphcabli..
<br /> • Oulline and dimenslons of au exis}i,� � Cwntc�hnn r,f���p„� �
<br /> proposed sUuclures on tlie lo�
<br /> g JO� • Inr!ica��� North �
<br /> • Existing and proposed utildics � `�'O�''�i��Y ^'enosetl c�ratlmr� ch:�n;�rn
<br /> _ M Sho�v mnaSUrem�MS
<br /> DO NOT WRIIE 6�Lpby 7Hig LINE m
<br /> PERMI7 CONDITIONS O
<br /> t.All c211s for inspection shall be made 24 hrs.in advacce�phone 259-881.?.
<br /> 2.All work shall be performetl in accordance with ihis permit and currect City pf Everett Design and Construction
<br /> Standards and Specilicalions. �
<br /> 3.Call location Underground Service 48 hrs.beloie you dig,TOLL FREE NUMBER 1-BOO.qQQ.5555.
<br /> 7• '/'�/�'llcLe /rnProv�rne.,f� CS.�dec�a L�E� a.S 7`�icc �
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<br /> � CON'7�GCf De��n.s G�zGlcr.,ar� �r /nsPr�¢;o„ 1�
<br /> DGTOY£ PO!/r'inq C OnC.,�Y�' /A4'c,� �
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<br /> D� Per AC ACKtv06'✓LEf GEF.tENi OP CONDITIONS
<br /> an �OC�C ___ - _. ih,.�m.1rr.�qnedowner,,
<br /> - � - --'- �PPI�c?nt hcreby agrees to hold ancl sa�r. harm�
<br /> , �"s �„- �-�Iv o� Everelt Irom any anA au Gaims for hpir,nq -osis
<br /> ; rxp��ses. nr �auses ol artion �hat may ans� 6ecause of in i �IP��inn
<br /> � �� ���� � `'°� m101�Pn�n�� �! �h� imnrove�nent or other ngh� obway us� h retn
<br /> Approved for Con r ction -- -- a .n��r , lor and f,rthor ��rees to icmovn samn u �
<br /> ��,�_�i/' ���' � C�ty,inr7lq r�pl,���Public nr e�ty dB�ged th�r���yn notice Irom �hF
<br /> FINALINSPECTION — �—���y _�/ . l � � " / "' �
<br /> r- " /
<br /> APProved as Constructed Date C C . .�� � � �-
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<br /> Siqnat e Apphcan! .
<br /> �A`a�� PUBLIC WORKS DEPARTMENT INORK Al!i HORIZED BY THIS PERMI7 M Dat .
<br /> 3200CedarStreet 1gp DAVS OF DA7E PE9h11T IS ISSUED ANUBTHEREAFT�ERVIS TO
<br /> Evrre�t,WA 9�201 I i3E DIL(G[Nil.1' FUFSUED TO CUMP�E710N. THIS PERIdIT ,'dPY BE
<br /> Phone:259-8810 � C4^JCELLEU EY THE G7Y UPpN ANY S?Gnpq�E OF WORK ON THIS
<br /> ! PRO,IEGT OVEF 90 DAVS DURATION.
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