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Date <br /> 3/�a��o �,�,,.�,�o,,,�.,m,,. 9n— ��s / <br /> b¢f�iocnt���'��� — <br /> AppliCation Por <br /> PQJBLIC WORFCS �ERMIT °°°'`""°",�" — <br /> r.,,.��e� S <br /> �,, ..<,.�� ����.,�„ s <br /> o� <br /> �,,� „�„� s ,�c. <br /> Print or Type Only <br /> �r � <br /> �o � x ,C'nc« 1�,`�ec /C n 9- / s'� r: �uE-.ec-rT 5�a-o/ � S7- � rS7-- <br /> � H[~nOwnm Mailing ntltlress Ciq� Zin Phonc <br /> H ��' <br /> H x H �LA—»c-c� ------. . <br /> .._ _-- - � - - - � <br /> �C C') MaihngAdtlres'��-����' [:�' -� Pncn.. <br /> y .� Applicant <br /> 'i1 H 'i1 <br /> VJ H <br /> Duscnhe ProPosed WcrA lUdW S. . . _ _ ---_ _- _- _ __—_ <br /> �O� _ .__-________—_ - -- <br /> H C7 <br /> � � g __ W <br /> L]V (] <br /> H L <br /> ay� /v ' 7 iJlEk) /l/06E ��f..' . - ---- — �— <br /> Proiect Address Uf tnownl <br /> t4 z �� <br /> H H Attach lour(4�copies of plans lor proposed work�Draw to scale and note Ihe fullowino as apphcaUle� <br /> �ay � • Propeny Lines • Centedine of sheel ��� <br /> �7 ry y • Outline arA A��mensions ol ail e.�sling and • Indiwle�icrth <br /> �Q � proposed s'ruciures on Ihe I,t • Show nn� p�oPcseA,7�auing changes <br /> �D� • E.i5lin9 and PfOF�Sed uiili!��s • SI'.ow a.�lsureinenls /� <br /> z �3 cn W <br /> H O VJ DO NOT WRITE B6LOlV TNIS LINL O <br /> r�� P[RMIT CONDITIONS <br /> I t.All calls tor insU�clion shall be made 24 hrs.in advance-phone 259•881 Q � <br /> 2.All work shall6e perrorm=d in uccertlance with ihis permit and currenl City ol EveieO Di�s��;o a��d C.nst�uction <br /> Stantlards and Suecifications. <br /> 3.CaU Location Undergrountl Service e8 hrs.6ebre vou Ai9.TOLL FREE NUMBER 1•800•424•5555. �) <br /> �� • • ' G <br /> ��� �� �c. Cdi t, �j ,� , ..-���c,�C'Ycl -�f-:. l:iJ-7!�!"(�i-a� .Y/ccC�i ,.ic�'� � <br /> i_�, � fLlh'. :.•`i-'� `_ � _ � V�. <br /> .cl�j� .� ' l.-��lc'E'�r/:Z� - ,�' . . � G"�J/:cc�j � <br /> ✓ �. <br /> ✓ <br /> � � �✓� . � <br /> �� <br /> �— � <br /> =' a <br /> P' <br /> �_ <br /> ' i1GKM1OlNLEDGLA1FNi OF CONDIilONS <br /> The untlei5i9ni'A OwnedaPPhG:In�hureJS��9�ees lo hold antl s.lec harm� <br /> '�1 1 —.--- ----- ----�—-- � I;�s��, the Cwly ol Everett irom any ind all dvms for dnma9es cosis. <br /> — r*penses, or wuses of aclion Ihat miy arise hec�use ol inst�llation <br /> � �nd mainien;ince ol Ihe im(�ovun-n� r othe nqhl ���'+n} U � I �ie�o <br /> � ���C'C-7�"� ��� ��� apPlied lof and �urlhCr �lr -�-., . � s�ni� u� .� '��-1 -_ I o�n Ih�• <br /> Approved foFConstrue � n � Date City and to replace public�� ac���� �J�+ i n..n 1.� <br /> / ��i— 3 �, <br /> ���' � �. (V(� f=c� — <br /> FINAL INSPECTION / Date -�--- ------- - —��-,;..- <br /> ApProvetl as Canslructed ' Signature oi APPlicant <br /> WORH AUTHORIZED BY 7H15 PEHM�II 1.1UST DE ST1f71[D lVI7HItJ <br /> evrmtt PUBLICWORKSDEPARTMENT ig0 DAYS OF DATE PERAIIT IS ISSUE� AND 1HERLAFTU� IS 10 <br /> � 9200C darSlrcel 8E DILIGENTLY PURSUED TO COMPLETION THIS PERM1IIT 14AV H�: <br /> Evcr�t� `.NA`J0201 G�N�GLLED BY THF UTY UPON ANV STOPPAG[ OF WOF7K O`J llbti <br /> ri,or,��. �ss-�eio � i>r,o.n�c1 ov[���n onvs our,;�liora <br />