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,: <br /> i <br /> I <br /> " P- I�l-Z9- r 9 .i <br /> DateG/L�/4i u / /_/t�S <br /> Pu�Lc Wo�AS Pcrmil a / <br /> � � � em oeo� ._ / r+�(n <br /> rn AP�lica;i�n Fo. A �{y�-�'�'— I <br /> �� PU�LIC WU�KS PERMIT Pub7olrF��r°° $ � <br /> 0 po <br /> � Less Ana�.Fec Pma � <br /> ; o O O 2�C7CJ <br /> Print or Type Only� oa����eo�e s <br /> 0 o I:� a�* � <br /> w <br /> ��; --� ���'� ��c�� �al�,N ��� y:y�9a asa-a� � <br /> pwner h o r� � Mailing Addres ..'iY Zip Phone <br /> 0 0 �-- w <br /> SQ�N�— d a o � <br /> Applicant Mailing Address City 2ip Phone <br /> r/ �..� <br /> Descri6c Propos�d Work ____��Ll� 1J1��(�31��+�,=-Q- ������ <br /> Q W <br /> Prolect Address(il known) �� � J V�2Ca l N I A _ �.rc _ � <br /> A�tach four(41 copies ol plans for proposed work- Draw to scale and note thn, lollo.viny as apphcable: � <br /> • Property Lines • Centerline��f street /A <br /> • Outline and dimensions of all existing and • Indicale North V�/ <br /> proposed structures on�he lot • Show any proPosed gradmc� changes <br /> ! Exisling end proposed utilities • Show measuremenis � <br /> DO NOT WRITE BEIOW THIS LWE O <br /> PERMIT CONDITIONS <br /> 1.All calls tor inspection shall be made 24 hrs.in advance-phone 259•88�0. � <br /> 2.All work shall be pedormed in accordance with this permi�and current City ol Everelt Design and Constmclion <br /> Standards and Specilicalions. <br /> 3.Call Location Underground Service 46 hrs.belore ynu dig.TOLL FREE NUMBER 1-800-424•5555. � <br /> � �Su�.eccv�� �.-+a(�2.E.�.a-�.. � �ze ,cr.T`..�t�i .��-co�id"'' O <br /> �` ..�.,�-o«e_ �fa.rt sto�-$�a,�-.� Lc,�-�. � ' �1n.v�/`-� r <br /> .� .�2c�2 �'�'i a.c..J . ♦A I <br /> 5. /�c�° �z.oa�lzr� c�irz��-�o7� .,�`t� �c.�et�N v♦ I <br /> O ' <br /> G�. �� Cif}/ Sfipe�S C�ea �� 2� a�( fiinzS � <br /> i <br /> � <br /> ACKNOWL�DGEMENT OF CONDITIONS <br /> .�� __ The undersigned ownedapPlicant hereby agrees to hold ard s3ve'�arm- <br /> � less the Cdy ol Evcrett Irom any and all claims tor damages, wsts I <br /> c� expenses, or causes of aclion th�l may arise becaose of in.tallation <br /> ��n/]C/� Z .�• Z��J� and maintenance ol �he i,nnrovemen� or other right-ol-way use hcrelo <br /> rr/ � applied tor and furtC=r agrees to re�nove aame upon notice �mm Ihe <br /> Apnroved for Cons{udion Date Cily and t i�ptace F�hlic pro�y damaged ihereby. <br /> G " � <br /> / ��G � 7-/�-`�/ � o -7 <br /> Fi AL INSPECTION Date � J ^ / cf/ <br /> App�oved as Gonstructed Sig at re of pplicant Datc <br /> WO K UTHOR12ED BY THIS PERMIT A1UST BE STARTED WITHIN <br /> everMt ' PUBLICWORKSDEPARTMENT �g0 DAYS OF DA1[ PEFtdIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200CedarStreet BE DILIGENTLY PURSUED TO COM1IPLETION. THIS PE!�MIT MAY BE <br /> Everett.WA�?B2o1 CANCELLED 6Y iHE CITY UPON ANY STOPPhG[OF�.NORK ON THIS <br /> Phone:259�8810 PROJECT OVEP 90 DAYS DURATION. , <br /> I <br />