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Date.��7-�qq – ��,��„�, w,.,.,��.�,m��, b',�-�.�� - <br /> . . <br /> AOPficnt�n For uine u�.m • _.—_-_' -___'_—__- <br /> PUBLIC WO�KS PERMIT °°°°�W°,"��° - ----- -- <br /> ,��a���� s-- <br /> oLessnnni ve�Pnnt S __ <br /> CS g � n.,�w��:�o,,,. S ��O�� _ <br /> Print or Type Only a <br /> � � � �is, ,�5;�7�/� <br /> M�,� �Ld.���.�,LI`�� � � �7�r� 2��� N�,�tcu�-KU��� �GS��a� <br /> Ownei � `/�1 M�n3 �`�U�-j COy Zip��r Phone <br /> CJ � 1— tL <br /> ; � � U <br /> 0 <br /> pnp�i�a�� Madmg AAdress City Lp Phone <br /> Desc�be Pioposed Work �G�` /�—P <br /> W <br /> Pro�ect Atldress 111 koownl �N� e � �, <br /> Attech fom�41 copies of Plans for proposed work- Draw to scale antl note ihe lollowiny as applicable� � I <br /> • Property Lines • Centerline ol sireet � <br /> • Out6ne and dlmensions ol all erisimg antl • Indicate North j <br /> proposetl slructures on the l01 • Show any pruposed gratling rhanges ` <br /> • Exlshng anA proposeC utllities • Show measurements � <br /> I <br /> DO NnT WRITE BELOW TNIS IINE O <br /> F'cRM1T CONDITIONS <br /> 1.All calls tor inspection shell be made 24 hrs.in advance-phone 259•8810. � � <br /> 2.All work shall bo pedormed in accordance with this permit and current City ot Everett Design and Construdion <br /> Standerda and Speclfications. I <br /> 3.Call Locatlon Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1•80�M424•5555. � � <br /> i <br /> � �G.'�{^a.-ncG �/'..lu J��.��.»cc .� `rt��c-_:� ��7tC/ '�itni.! 7I��1C2G._/ O <br /> .� �,� ,�-L�r..� ���s�,.��:d _����r „� �.�;�- ��: <br /> , .�/ , <br /> �' ' ��h7 j �"2t �� �Cc2G� ti/�G ha��a�f 2�LCG�'/�✓� � ,I <br /> �.l:,ca..� <br /> ��/ .Lto�.[ic �'e�/�-Y! C y /i'z�C,1� ��'� 2�. E� � �t.� t i <br /> X� � � <br /> � � l <br /> �C����IrzK. �C� .L'ri��7' . � �, <br /> a <br /> .n ACKNOWLEDGEMENT OF CONDITIONS <br /> ...�1Lh _ iheundcrs�gnedowneUspplicantherebyagreestoholdandseveharm- <br /> �y� <br /> - Iess the Cdy of Everett Imm any and all claims lor damages, costs. <br /> expenses, or causes ol action Ihat may anse because ot installation <br /> �� `/ /�^ ' and maiMenance ol the � rovement or other right�obway use hereto <br /> % 12�:'��' /J1Cc.'-�>2 -S �3 �y apPlied for and turthe agr to remove same upon notice Irom ihe <br /> Approved�or Consiruction a�e Cily and t �replace u�� r �erty damaged thereby. <br /> ���-S ��f� �1 � � <br /> FI INSPECTION Date � � - <br /> Approved as Gunstructed i li �e <br /> �ORK AUTHORI BY THIS PERMIT MUST BE STARTED WI7111N <br /> everett PUBLICWORKSDEPAR7MEN1 180 D�YS OF DAT PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200CedarStreet BE DILIG[NTLY PURSUED TO COMPLETION. THIS PERMIT MAY 8E <br /> Everetl.WA 99201 CANC[LL[D BY TNE CITY UPON ANY S70PPAGE OF WORK ON THIS <br /> Phone:259�8010 PRUJ[CT OVER 90 DAVS DURATION. <br />