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/ <br /> _u �,,,��„� ,,,,_,, , . �7- ��u <br /> Date J <br /> �=�=�_� � � .�� �,.,.� . .��_ _l�-Lci�- <br /> nnui�c,rm, ror -- <br /> PUBLIC 'NVORKS PERMIT `'"—°"""°`",`"" <br /> intel Fce S-- <br /> 1 rss A00� Foa Pab 5 <br /> Palanco Le 5�� <br /> Print or Type Only <br /> A 1 !H��1-�Y11 E�S znr , ��S l.��/�1�I �J �L�f I. �-1829� �/£SS-9bC�� <br /> Owner <br /> tdaiiing Address Cily Zip Phone <br /> �p �i�Y _— ZiP Phone <br /> APU�;,` Mniling Address '� <br /> i <br /> n 1�' '� ��'K <br /> Describe Proposed Work _.L.L+,�I,�I <br /> - W <br /> 2.5���= U,>wc.-c�sf �c�s �o+ �- �� � <br /> Project Address�il knownl __ <br /> � <br /> Attaeh lour(4)capies of plans for proposed work- Dm�v lo scale and nole th�followin� as aPPlicable: � � <br /> • Properry Lines • Cenlerline of clreet <br /> • Oulli�e and dimensions of all existing and • Indicate N�rlh <br /> prot��sed struciwes on ihe lot • Show ai > proposed grading changes <br /> • Eaisting end propo�'ed utilities • Show meusurements M <br /> W <br /> DO NOT N.'91TE EEl OW THIS LINE O <br /> PERMIT CONDITIONS � <br /> 1. All calls for inspeclion shall Ue made 2A hrs m�dvance- phone 259•$81 5. <br /> 2. HII work shall Ue perlormed in accordance wilh this permil and current Ciry ol [v��•.�Il Desiyn and Conslruction <br /> Standards and 5pecfications. � <br /> 3. Cnll Location Undergrcund Service 40 hrs.hefore you dig.TOLL FREE NUMP,ER 1-801)•�24-5555. <br /> �G�G/AG ��'/!/Fal9y LOL97io/�l O�/ /?iU/�E.C�Ty /S niOT 9s O <br /> ,9j/c�u,�•t� Git,� SiTE �=9N /1�c"CuNSTr.ucT [�di�/EaJ9� <br /> TO Ci y ST9n/G/J.e✓J �.�'U7 f)ND .(�Emo✓e EX�.;:ii✓G- � <br /> l�.Pi<�cJ 9� PE.t' ��i/ S>9ti�o.9.c>os- SEc r�o�✓ � 3. 3. 7 <br /> � <br /> O <br /> � <br /> ACKNOWLEDbE!IF.NiOfC�' 71TIONS <br /> Theundersignedowner/ap,r,lmantheirbyap� 'oholdandsaoeharm- <br /> -- Icss Ihe Gily ol Everett Irom ��ry and all � for damages, cosis, <br /> , expenses, or causes ol actio^ that m�y .� ;_ .�cause ol installation <br /> �/ . s �� � 7 and m�intenance ol tne impnnement er� �� rlght�of-way use hereto <br /> � J �G,.b.ljy G G / �pplied lor and (urlher aqre�s to remove .��.�e upon notice Irom the <br /> qpproved lor Cori � tion ��� Gity and to replace public p�opeily dam�ged thereby. <br /> / �,p / / <br /> � � �'/�—_ 1 /: _' <br /> i CA (C/ <br /> ��/l i � ��%'.� �' <br /> FINAL INSF'ECTION DatA ala <br /> igna�ure ol Applicanl <br /> Approved as Conslrucled <br /> WdRK AUTHORIZED BY THIS PERMIT MUST BE STA(iTED Wf� <br /> rvciell PUBUC N�ORKS DEF.iRTMENT 1A0 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200 Cedur Sireel �3E DILIGENTLY PURSU[D TO COMPLETION. THIS PERMIT MAY BE <br /> Everet�,VJA gg201 CANCELLLD DY TH[CITY UPUN ANV�TOPPAGE OF 1NORK ON I�HIS <br /> Phone: 25�'Bi315 PROJECT OVLR 90 D�1'S DURATION. <br />