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. �< <br /> Dete IQ-�O•�? weu�wa..v..,,,�. ��Z <br /> Application For ewp o.o�o <br /> PUBLIC WORKS PERMIT �a�F» , � ,:''�; <br /> � �...�oa...v.b s��, . <br /> PNnt or TYpe Only e.az.o,„ s_20— �.�*� <br /> ;c:. <br /> ' �,;{; <br /> �tvR�1r� 'x1�7 C1Fi"� IZRx�� LJl'Q� �lS3ZO�j 3SS -G�9 �% <br /> ,. , Owner Ma111npAdOress CIIY ZiP Poone �:.. <br /> :t �br� �t2Flt�1�� 9q-�s2 r�r,�z vn--�,�= F�uge4�- 9V,2��j �S'� C6�3� i"/`_: <br /> ,i. Applla�nt MsillnpAddroea CItY ZIP . Phone .i�,•,� <br /> i1 . •` <br /> i <br /> '4 os.a�oeRop,s.awork T7v��»� L..fRv �,.�,'�' <br /> } 1,A <br /> 1 <br /> J. <br /> � �W��■( <br /> 3�, : ' h._.: w. . . . . }� . 1�1 <br /> F��'�Afbf!{��H�U17W11� ��-/ � �������-•�_ ���R�'�.. <br /> '!.' Att�CA four(�)eOpN�d p1�n91or proposed work-Dnw to aeale�nC note the lollowinp as applipEle: �, <br /> � <br /> � ���m�� •Centerllne ol elreel <br /> •Ouqlns anA dNnenaions ol all axlatin9 a�+d - • Indlute Nonh �-� <br /> WopowA atructurea on I�e lot • Show any p/oppsetl Orading chanqee <br /> • Ex�atln(�uM proposad utllNiea • SAow meesurements <br /> � � DO NOT WRITE BELOW THIS LINE ���� <br /> PERMIT CONDITIONS ��i <br /> 1. AN pW lor�n�p�ct�on a�sll be maae 24 hra in�dv�nca•pnone 259•8815. <br /> 2. Ap wak�MII be performed i�accordar.ce wR�thia permil entl currsnt Ciry ol Everett Dosign and Construdlon '. <br /> [ St�nduM�nA Specllkalbna � , , <br /> { 3. GII�ocetlon UnderOround Sarvica 4B hra helore you d'p.TOLL FREE NUMBEH 1-800�424•5555. <br /> � 5! /2 ~�i.Di„�rE2 covc.�� d.P.u��� Ti�f ' � <br /> � — C�/�lC ..gE ,t'�-�U,cPj�O /F D,Pi!/EW9�/ /,f' Ta BE ;� <br /> � /.t/STiR'CEO /,r/A 4�TlS� SECT�Lu� � <br /> �. I�t/.t.o�cT.o.d cu! T.YE • ` „ <br /> + CvGv.��e�'::iyi[c' '�7E`�C'-Ad'T557 � , <br /> � �Q(li.f�0 !,�'Ei�OA'E /T /S �Oli.E?,�Q . � <br /> i LLO.e.0 S�srC 9E /N ComtYi9,vC,E V �4Jir� ;,, • <br /> s�br,�aV F. ��. 2 of' TN� E✓'�'.e.E7�'c3'�?'�kdf � . <br /> �y, .1cb.r. ��9nqnY.�aJ .:.. . <br /> _� o�le�*�I �. <br /> /S��!/�/ /l7911/iN� CIE��C'/HG !�/iGC .f'EGJU/.PE <br /> U�e2 2c�c= �b A�do��no.�yc P�.F.�ir_ <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> Theuntlersipnedowner/aDPlicunlherehyagreesloholdendsavebemr �� <br /> less ine Cily ol Everelt Irom any anA ali ciaims lor damages, coata, � <br /> � � ��. eMpenses, or causes ol aclion Ihal may ariso because ol installallon j <br /> �,�` �C��_�� and mainlenance ol Iho impmvement or Ihar rig�hobway use hereto �� <br /> Approv Conslrucuon, applie lor and luriher a e to remov same upon notice Irom !he <br /> l� Date City a to rcplaco p bliC r amag d Iheroby. <br /> ��'�-'.( l�1L�'-� ��` �',�'��`�e o - '3-8 j <br /> FINAI INS ECTIO r •'- / I i <br /> Approved as Conetructed i naWrc ol Applican ete <br /> pverett PUBLIC WORKS DCPARTMENT WORK AUTHOFiIZ.ED BV THIS PERMIT MUST BE STARTED WITMIN <br /> � 3200CeCarStreol 180 DAYti OF DATE PERMIT IS ISSUED AND TIIEFFAFTER IS TO <br /> Everelt.WA 98201 BE DILIGE>7TLV PUi7SUED TO COMPLh1:ON.7HI5 PEAMI) R1AY G! <br /> P�one 259•8815 CANCcI'_EJ BY iHE CITV UPON ANY STOPPAGE OF WCRK ON��5� <br /> PROJE'.iOVER!IODAYS�URATION. • � <br />