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oai����r]��� � : _ .. . �/���/��/� <br /> NOPIiraLon �or -� n...� •...��. ��"`��.CC�V <br /> PUBLIC WORKS PERMIT ° � �,�°�.���� -- . <br /> ,�„��.. s — <br /> �....,�,�.:,��,•��, s __ <br /> P�iM or Type Only �"��',�. ..�..". ' - --- <br /> Hr � —`-�1"I� 1�1��"�� W`Y��'�I(�' `. /�� �� q�sr�U� <br /> � a y Own� A1ad�. Atld�ess C�ty ,J �p Phone <br /> ,o x x �Jy / — '1 <br /> � y � __��_ <br /> qUpii�a�� Mailinq Atltlress Gty Lp Phone <br /> y �-�+ /' n <br /> O x O D<�scribc Proposed Wwk �"-1--�f� �� . _ <br /> 'il H 'i1 <br /> U1 H __ <br /> H Cg – <br /> � O t+] ' <br /> �OHe ��:/'./+� —' _ W <br /> � � Pwlecl Address pl knowN � 4 o J� �/ � � � <br /> �j]Y �] <br /> H � <br /> x F{ � Aliach IOur 14)�opies ol plan5�or prOP05fd work- Dim�In scnle;�r,tl note I��e lo Imviny as.�pp�coClr �� <br /> .�.� y �, • Property Lmes • Centerline n!��reet /w <br /> H y • Outl�ne antl dimens�ons of all exis�in9 and • indra�e Norlh Vr� <br /> t�(/�H propesetl sUu[lures un Ihe Io1 • Show anY PruPoSetl qradiny r'�anqes <br /> �j d� � [�isbny nnd propcsed utditics • Show measurements � <br /> �� � o_ <br /> DO NOT 1"rRIT[ BEL014'THIS LW E <br /> y O (n PERtdITCON�ITIONS O <br /> � 1,All calls br��spection shall be m�de 24 hrs.in adv�nce-phone 259•8810. � <br /> 2.All work shall�n pedormed in accardance r.ith ihis permit and cwrenl City of Evemfl Desi�n and Construction <br /> � � •� S�andards antl SCncil�cation;. <br /> �� 3.Call Location Undei�rounA Sen�ice 4B hrs.belore��w C�9.TOLL FREE NUMBER 1-800•424•5555. � <br /> i <br /> �'� Q <br /> , . �� , � _ � <br /> �-- <br /> , __, V� <br /> O <br /> "�'� a <br /> 71� <br /> ACKNOWLEOGEL1ENf OF CO'IOIilONS <br /> �i �no undcitiigned owneVappliCani hereby agrees Io holtl nnd s;rve h.,�m� <br /> I --� ' cess ihe Gly ol Everett Irom any and all claims lor Aama9es, coslc. <br /> �.penses. or wuses ol aclion Ihat may anse because of mslallation <br /> I '� r,nA mamtenance ol the improvement or oihm ngh4ol�way use hereto <br /> 1� — -- ----- :ipplied br and lurth�r agrces lo remove same upon nolice irom the <br /> � Approved�o�Con5lruchon ����' Cdy and to mplace puUlic property tlemaged Ihereby. <br /> FINAL INSPECTION Date <br /> Approved as Construcled Signalure ol ApPlicant Da�e <br /> i•cerett PUBLIGWORKSDEPARTMENT WOf;K AUTHORIZED BY iHIS P'cRM1T 1.1UST BE STAR7EG WITHIN <br /> � 3200CeAarStreet 1B0 DAYS OF DATE PERMIT IS ISSUED AND THEREAF7Ei7 IS TO <br /> Evetrll WA 9A201 BE DILIGENTLY PURSUED TO COMPLETION. TIIIS PERId1T �dAY B[ <br /> Phorc:259�eB10 CANCELL[D �Y 1'HE CITY U?ON ANV STOPPAGE OF VJOF7K ON THIS <br /> PROJFCT OV[R 90 7AYS bUFi 7ION. <br />