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/ " <br /> � <br /> .� �.� i: <br /> Gate��, , ' <br /> Nuoim wo��s p.,mn. R4�3� <br /> Applica�ion For M eieo oeo� • <br /> PUBLIC WORKS PE�MIT P,�����W�.�.F<e — <br /> ro�a�FPr s <br /> iesx nooi v.e va�n 5 <br /> Print or Type Only q g � er�r��«o�� s ..� <br /> o 'r`�' r�i <br /> � M '" �S C. <br /> 80,✓ .S/-a.vs�.✓ 3 Fr� 7 ��,�k�,? ��- <br /> � �E:a�7T .y.�Y -Z/y/ <br /> Owne� A1a�,in,; 4r.Jrrss Y� � � �j �ny 7_in Phane <br /> � oxw <br /> S/Q �n 4' � a o � <br /> Applicant M,d��+.q Addn�ss .'__ — _.— <br /> - C�tti' ZiP Phone -- <br /> DescribeProPosrdWork ___��j1!G (l __. � ? __ T�NGY �Tv ?h <br /> __ _ � <br /> Prolect 4ddress Id known! ___ _ �'✓OO .____ _'__ s /r�_�� � <br /> — -- - —5----- _ �„ <br /> Attach four 14)copie5 Ot plans f�i pioPused wn�K pia�r to _,:,�;,.,,;�� ����„�i��, ��Ilcwinq as anphcab�e_ <br /> • Property Lines • Cenf�• — <br /> rhnn nl Sirr.•I � <br /> • Ou�lme and Aimensions ol all esn;mq nnd • ;r�ical�_ North <br /> proposetl slruclure5 on Ih�Int O •��.nw any rreposen��ra7mo [ttnny��s <br /> • Ex�anng and proposed utihties • Show mrasuraments <br /> DO NOT WRITt 8[L`JW iHIS LINE � <br /> PFRMIT CONDITIONS O <br /> 1.AI�calls for inspection shall be made 24 hrs.in advance-phone 259•8$10. <br /> 2.All work shall be peAormed in accordance with this permit and current City of Everett Design and Construction � <br /> Standards and Specilications. <br /> 3.Call Location Underground Service 48 hrs.belore you dig.TOLL FREE NUMBER 1•80p�424•5555. <br /> �, .�wvu.r SNa bl �l'►.s�tdl 5`dcwx.l k Y� G�� Sl:d #,3o(v a.�d q � <br /> Yt?,� dn'Ucw.u1 a�prw! �r s'�J 1��j-7_ O <br /> S �� Siy7-f o6surr�J�..� -fG,1�� PG►' Zo h;ti+/ U,.,vYw�.+1?i � <br /> S lvv vl l��c, �1.� S-� G� c s E•.�l( a s I aH r/sca�/�.� ro 'Fiyw t � <br /> n / - GJ��77'7 r,/��� O <br /> Cl � /7 ��riYYria'LGC �/G✓R✓I 7T c Ih k L1 bC $✓{�-rt i��i /►'�� <br /> [� <br /> n �� <br /> ct�w..,�4'`-o y' �Sl� .�+ /Cc✓ e� i�n n�e d/z�f�e ��.s� ���`-�-. c�{ <br /> LG7y15GCtp l�'i% 4 N C� s��+,�l.f.J� ��. qCKNOWLEDG[h1ENT OF CONDITIONS <br /> I <br /> _ _ i�ti^�i��de���anedowner;apphcantherebyagreestoholdandsaveharm� <br /> ' � �,�ss th�r Qty Ot Everetl trom �ny dnA lll ctaims for tlamageg, cosls. <br /> �`�P�'r,ses. or causes o� achon that may an5^ ber.au5e o� Installation <br /> � anA maintenanr,e nl Ine improvemeni or other ngh�-ol-way use hr.reto <br /> APP� Qd r C str,uct i ---� � -��{ �n���nd �er and further a�rees to iemove samn upon notice irom Ihe <br /> � / � r"��� C�;s .u,d In replace pub6c pronert dama ed thereby. <br /> vt F � Pc'r: �o �� � P 7 �uT c_; Y 9 0 1�9� <br /> NU ,- / ,� ( _ ,�� � � � � <br /> FINAL INSPECTION �Y Wl�L1�sAai� i"��� "'�-_— _1,7l�,fLrr <br /> Approvetl as Constructed ���� <br /> � 1 S�pnalw e o l A p p l i C a n! Date <br /> ���vP � r��J I IVORK AUTHOR12ED BV iHIS PERM17 MUST BE S7ARTED WITHIN <br /> PUBLIC WORKS DEPARTMENT__ <br /> 3200CetlarStreet (� �� —�"'� /�'��90 DAVS OF DA7E PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Phone,259 B810� /��a / O � S U�j % �I��LED BY THE C TYD PONONV STOP AGEIOF WOrRK ON THIS <br /> .�L/ ��7��� � PROJECT OVER 90 DAYS DURATION. <br /> 12.-27- ,� I <br />