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l <br />� <br /> i <br />!' Date�(.J� ���ei��rro�w.w., i. � -- <br /> " ( / oiao.oeo�.• � <br /> Application For <br /> PUBLIC WORKS PERIMIT rubTaWFeaFee S <br /> less ApO�Fea PaiE S <br /> DaiancaDuo $ <br /> Prinl or Type Only <br /> `���.�� Ct��tid I��,� JTs�y U,� � �'Q ��s�= ��,c3 <br /> Owner Mailmc�Address �� Gty Zip Phone <br /> ) r �" <br /> `�c�...�. � C�, �,� �v�.-�. �;y� c�f� '�'` _ 7y� -� � � , <br /> � <br /> Applicant ailing Address Ciry Zip Pliune -� <br /> n <br /> r� <br /> � .. <br /> Descnbe Proposed Work � — M <br /> -� T <br /> r �--I <br /> N 1 <br /> � m <br /> vo <br /> — . � mc <br /> Project Addre<5(il known) — n <br /> 0 3 <br /> Attach lour(4)copies ol plsns br proposed work- Draw to scale and note Ihe following as apPlicable: � �' <br /> � --I z <br /> • Properry Lines • Centerline ot street = � � <br /> m <br /> • Outline and dimensions of atl existing�nd • Indicate North <br /> O Show an r000sed gradin rhr.n es � � <br /> proposed structures on the lot Y p g 9 <br /> • Existing and proposed utilities • Show measuremenis � r- _ <br /> — —1� � N 1 <br /> DO tJOT WRITE BE�OW Tt115 LINE O -< <br /> T <br /> PERMiTCONDITIONS � D I <br /> ' <br /> 1. All calls lor inspeclion shall be made 24 hrs. in advance� pl;nne 259•88 i S. � = m , <br /> 2. All work shall be perlormed in accordance with ihis permit and curr�n!City ol Ev��ret� Desin�����d Consiructiun �,-i � <br /> Standards and Specilications �� <br /> 3 Call Localion Underground Servicc 4p hrs. before you dig.TOLL FREE NUMBER 1•800-424•5555. � ��� <br /> C N <br /> 3 v` <br /> O m <br /> �,�-s `��'� ?'%'� � m <br /> ��� ��������� ��� � � A <br /> ��J%a``�r' '- � > <br /> ,. , <br /> �7�:��7�1i/��'� � , ,S-�`;,,�'-� � - <br /> ; <br /> � � Q s <br /> v <br /> ^ c <br /> ri� <br /> � <br /> m <br /> ACKNOWLEDGEMLNT OF CfJNDITIONS <br /> The undersigned owner/applicant hereby agrees to hold ond save i�a�m- <br /> les5 lhe Cily 0� Everel� �rom any and all claims for damages, co;is, <br /> expenses, or causes of actlon that may arise because of instatlation <br /> and maintenance of the improvement or olYier right�of�way use nereto <br /> applied lor and further agrees to remove same upon notice irom the <br /> Approved fer Construction Date Ciry and lo replace public property damaged Ihereby. <br /> Fi�Jl�L IDlSFECTION Oate Date <br /> /����novetl as Conslructed SignaWre of Applicant <br /> WORK AUTHORIZED BY THIS PcRMIT MUST BE STARTED WITIiRJ <br /> ,�����«�[t PUBLIi:WOFKS DEPARTMENT �g0 DAYS OF DATE PERMIT IS ISSUED ANC THENEAFTER IS TO <br /> � 3200 Cednr Sireel BE DILIGENTLY PURSU[D TO C0�4PLETION. THIS PERMIT MAV BE <br /> [vcretl. l"!A 9ft201 CANCIiLL[D�V THF CI iY UFON AN1'STOPPAGE OF�NORY.ON 1HI5 <br /> Pl�ona. 2'v9�f3B;o RRC,.�LCi O"FR JO DA1'S DURATIO�d <br /> I <br />