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� C � <br /> m <br /> ay <br /> C � H <br /> > H � <br /> rx9 <br /> yZH <br /> K O <br /> H � <br /> 'i1 H '�7 �. . p <br /> �C�1 ' _ ,3� 3 <br /> Ul H flate:J'�a� t�' Y �� n.m��wo,�.avmn. �L--. <br /> �z pa P.kf� DeVI • ___ <br /> O RJ ApUhrnliCn for <br /> H C '. . __ —__ <br /> PUBLIC WORKS PERMIT �'.�°°w°°°`�° <br /> H <br /> ,�.,,,�,,.� 5 — <br /> H� g < �...;,,:,,. ,�..��.,-� s <br /> c� o ;; <br /> H � <br /> r�. o��„ ,.n,�,. S .3>� <br /> zH � ,� , "' - -- <br /> y y �. Print or Type Only „�_ -�LSD���'��- � <br /> ty H H ;��✓ �r�"E. <br /> � � «� {� <br /> N �""� � s()�� .,�., (J:C47 d f , �l,( <br /> gC r y =��r,�ff Sr �,,�,,I `��� E��,� <br /> �y � r Owner Mading Atldiess � '� � � .,Cily 2ip Phone <br /> U O �r3 U <br /> � � " `� � ' �i3Z- �3 7 <br /> y o c`�n G �c a�n kru� Co �:t �Pfl, a�x Q-(r�� � ".7�a,�fle 98121� 1 <br /> Applicant Maihng Adtlress City Zip Phone <br /> -� /� �{... }; <br /> Descr�beProposedWork ! � C I�l � f ��• SC�.0 a� l7�nin �� � �('t(iSi5liiiy s��fr . _ <br /> l <br /> C�, <br /> Prolect Addrnss 1�1 knowN S�I D U't W �f• V1I�/[�� ----- � <br /> Attach lOur 14)ropies o�plans lor propOs�d�vork� Diaw to scile,�nd note Ihe lollow�ng as applicahk� � <br /> • Property Lines • CeMer6ne ot ctreet /A <br /> • Oulline and dimensions ot all e*islin9:md • Indicale North V� <br /> prOPosed struClures on Ihc lo� • Show any proposeA.pudiny chan9cs <br /> ��� • Exisimg and propo5ed utilities • Sho�v nieasuremenis /�/� <br /> ' ' �O NOT 6VRITE BEL.OW THIS LINE O <br /> � <br /> '�1 PERMITCONDITIONS <br /> 1.All Calls lor inspeCliOn Shall be made 24 hr5.m ativanCe-phone 2$9•881Q ^ <br /> 1 � 2.All work shall be peAormed in accordance with this permil and curtent Ci�y of Everelt Design and Gonsiruction � <br /> � Standards antl Specifications. <br /> 3.Call Location Undergwund Service 48 hrs.before you tlig.TOLL FREE NUMBER 1•800•424•5555. � <br /> � <br /> 'f O <br /> � F�/w] <br /> —/ <br /> ' O <br /> _� <br /> a <br /> � �GKNOWL[UGLI,IENTOFCONDITIONS <br /> The untlersigned o'n'nevapphc�nt hcicby�grees IJ ho�tl nnd sace hn�rn- <br /> � less ihe Cdy ot Everett Iram any and ali claims for dama�es. costs. <br /> expenses, or causes ol action ihal may arise because of installation <br /> ,7 ��; �- and maintenance ol �he improvement or other r�ghl�obway use herelo <br /> ���� � f7 - � � applied lor and �urlher agrees b remove same upon notice ��oin Ih�: <br /> npu�oved lor Cons�ruclion � Date City and to replace public p�openy damaged ihereby. <br /> ��� F�� � / - � �� <br /> . � <br /> � <br /> FiNA1 PECTION Date ' <br /> � �__ <br /> Approvod as Constructed �Signature ol AnPhcant <br /> WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED C:Ir!uN <br /> c�rrelt PUBLICWORKSDEPARTMENT 160 �AYS OP DATE PERMIT IS ISSUED AND THEREAFTER IS l0 <br /> � 3200CetlarStreel BE DILIG[NiLY PURSUED TO COMPLETION. THIS PERA1IT Idi�Y e[ <br /> EveretL WA 98201 CANC[LLED BY THF CiT1'U�ON�NY STOPPAGE OF IVOf?K ON iHlS <br /> Phonc'.359�8670 PROJF:CT OVSR n0 D�1V5 DURATION. <br /> � <br />