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�a"{�. /� <br /> �y�( 51,. �� ��C� 1 Pubhcl'lO�h9Pn�m��• / —��� <br /> DaVd��1' f u�au o.�o� , --- <br /> ApP��r.atien For 3 __._ <br /> P <br /> PUBLIC WORKS PERM�� °"°'""°.`_`�° . <br /> ,o„�Fae 5 <br /> t7 lessn:oi �c�.Pa:t 5 <br /> p 7 �� <br /> b O g Paian���ow 5 G '� — <br /> = n - <br /> Print or Type Only ¢ ' <br /> � o � <br /> / 7� I r��7 t( � �° I,CJa� zS$-`1369 <br /> %1/I .� �E' I /i9 ►7YlCoh J /��ys �N��re�f�' <br /> o � r Q j�p Phnnr <br /> OWnP \ ,. i . �atln�ss � <br /> � � oU --- - <br /> SQWI '�— - -1Adn.sS .—__——_`--- i�P '—_ — Phona <br /> Applitant <br /> 6.,�Imq <br /> DescribePr000sed'slork _/'�_Q�OV`e—���--�r�� -��r��S �—_--��- . - - <br /> - ----- _ -- ---- ------ , ,--- W , <br /> -C- ��y G- �-��L����t� � ���-- F- <br /> Prolet�Address lil known! ��-`�+-.—�-"��—�-�`�-�"--�-- �'�U,(/.G pY. <br /> � <br /> Altaeh tour(4)coP�eS of 'ans foi P�nPo�e�l wu�� D�av. to -,:d'i.• .c,.l nC.h1 Ihr�Oqc:�ing a:;aoCAiraNe. � <br /> • ProPerty Lmes • Centeihnr_ n!sfre�t <br /> • I�dir.at�) North <br /> • putline and dimensions ol a�l exiehnq and � c„�,ti.�ny r.roposed i�mC�nn cnangrs <br /> proposed s�ructures on Ihe lot � 5��,�,H measurentenis � <br /> • Erisfina and P�oPosed utilrties <br /> DO NOi WRI1�E 6ELOW �HIS LINE O <br /> PERMIT CONDITIOYS �\ <br /> 1.All calls for inspection shall be made 24 hrs.in advance-phone 259•8810. <br /> 2.All work shall be peAormr.d in accordance wilh Ihis permit and wrrent City of Everett Design and G� �siruction � <br /> Standards and Specifications. � <br /> 3.Call Location Underground Service 4B hrs.befo•=you dig.TOLL FREE NUMBER 1•800•424•5555. <br /> O <br /> � <br /> � <br /> O <br /> a <br /> AGhNOWLEUGL`^rNT OF CONDITIONS <br /> �i!i�.�indrvisiqned owneiL�PPlir.'r.nt'1ma.UY a9rees to hold anA save harin� <br /> 11,� �+� ._S'Yi'✓��� ' —� -�- � -- ", h��s tn��. G�ty o� Everett from a•�y and al� ctaims lor dameqes. costs. <br /> p.ponses o� causes o� �r,tion ihat may eris= becauso of insla�lal'ion <br /> -------/��— //� — / '' anA maintenanr,e nf tl�e improvement o� olher n9h1-of�waY use he�eto <br /> L' �l _� �j ��_ I ,i^pPe': inr end turiher :�grn�.� to �emove Samc UPon no�iCc Irom Ihe <br /> / L':de . �-;,, n �.:f to irPlaco cabLc p�onertY�ama9ed therebY, <br /> App�oveb tor Consiruc�ion , � <br /> �� i <br /> I� �i� A .�Y/!��'�— <br /> FINAL INSPECTION ��t� � ���� <br /> i ionatu�e of AnPlican! <br /> ApprovedasConstructed � ;',OP.i: ,1UiHORIZfD 8� 'S PERMIT MUST BE SiARTED WITHIN <br /> PUBLIC WORKS DEPARTMENT � tqp DPYS OP DATE PF��'�� IS ISSU[D AND THEREAFTER IS TO <br /> ��r�� 3200CedarSireet BE �IUG[1JTLY PURSI '? i l GOMPLHTION. THIS PERNIT IdAV B[ <br /> Everett.WA 98201 <br /> II CA^JC[LLEU BV THE G��'UFON ANY STOPPAGE OF WORK ON THIS <br /> Phone:259�8910 �. PFO.iEGT OV[R 90 DP�"� DUR��TION. <br />