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� <br /> ,ti <br /> r <br /> • 2 ��,� „� � P„��,�,vo,,,o...m, ' + '� <br /> Datell'L=—�- t;��aor�� . f'7�._._-�.3L2`t" . I'I <br /> ;,�n,lira�mn Fn� .. <br /> PUBLIC WORKS PERMIT ' ""° "".� - <br /> r�„�.�� s- <br /> ��M ln]SP�I�� �nnf�.l��iS� -- <br /> TO IlIJ1INlj _0�—� 1' 13 0,,� ..n,�. 5 <br /> p�x Print or Type Only �-- <br /> >H C/� <br /> 1-� .I Ct�P. �lkur� 3�l17;r,,�Aie �=��Ptf QJ'zv�355- 9tSb <br /> H �� �,y�g,Pln � IdaamyAnAicss Cdy ZiP Phone —__ � <br /> K y� Owne� <br /> � yH --._..__ _.______ -- —__ <br /> � x� —""� M:i�bngAtldress C�Iv ZiP Phono <br /> o ApP6r,an1 A <br /> O M d q (��, , N1 //� _"—__. <br /> N ��y Desr.ribe ProPosed LYork ___IJ�SL�LY11—�-r��d✓'���O--S-1 R��Z=�Ll�n'1-w�#�-/� r u <br /> G]. C� YI_L'L1�—k('��D-���a-f_0.Cr� <br /> xy� __-- W <br /> � �y � <br /> �' .3�! 7�.5� � <br /> �., dIP_ un <br /> � d y aroiec�Address li� hnownl " <br /> ❑ � <br /> � [s1 C'� Attach lour IQI copies o�P�znS�or propo5ed wo�k� Draw tr,sra�^ md nnir. ihe lo�low�ng as annLcaUle. � <br /> � � PrOP?<<Y LmeS • Centerline o�sireel <br /> x �-]y • InAicate Norih <br /> y p p1 • putlme an�dimenslons o�211 e.isting and � Show any proposed 9raAinq chanyes <br /> pio0�setl s�ruciu�es on ihe Inl � Show measuremen�5 M <br /> • Fnstiny antl DrOp�Sed�ihhhes � <br /> DO NOT WRITE BELOW TMIS L�NE O <br /> PERMIT CONDITIONS � <br /> 1.All calls lor inspection shall be matle 24 hrs.in advance�Phnne 259•8810. <br /> � 1 2 All work shall be pedorm�d in accordance wilh this permit and current City ol Everett Design antl Co�slruction <br /> Standards and Specilications. � <br /> '! 3.Call Localion Underground Service 48 hrs.bebre you dig.TOLL FREE NUMBER 1•800•424•5555. <br /> � �' ♦ O <br /> � � <br /> � ._� �� � ��/�,�,� �-9_�,2�I i �'� �%"c-�_ � <br /> i .� 11�� <br /> ��; � � '. OS � <br /> �. _ <br /> � � � �_Y� a <br /> ! ! -{���� 111 ��;.� <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> '� _ The undersigned ownerlaPPLcant hereby aqrees to hold anA save ha<<m <br /> �— — less Ihe City of Everelt hom any antl all claims lor dama9es. costs. <br /> CKpenSeS. Or CdUsl'S ot aCliOn IhO� m:1y anSC Ul'C.lUSC Of inStdll�iion <br /> anA mainlenance of the improvemenl or o�her npht�o4way use bereto <br /> applied IOr and funher agrces to remove same upcn notiCe Irom �he <br /> . " Dale Cily entl to repllCe puUlic proPeiN tllma9eA Ihereby <br /> Fpproved�or Construction <br /> FINAL INSPECTION ���'� - — Da1e <br /> Sy)natwC ol ApPbcan� <br /> ApProvetl as Constructed yypqh AUTHORIZED BY THIS PERMIT h1U5T BE STARTED WI7NIN <br /> 0 i.�,�,��.�� PUBUCWORKSDEPARTh1ENT 1t30 D4Y5 OF DATE PERA1IT IS ISSUED AND THEfiEAFTER IS TO <br /> 3200CedarSireel BE DILIGENTLY PURSU[D TO COMPLETION. TNIS PERM1IIT MAV B[ <br /> Everetl.WA 98201 CANCELLEO DY THE GN UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone'.259�8610 PROJECT OVGR 90 DA�S OURATION. <br />