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oate_IQ_-1Q-B`I �,,,�,�,v�,�.F.,m,�• --- - -- _. <br /> Anphcalmn Foi oinn orn� • --__ <br /> PUBLIC WORKS PERMIT ��������w��"��a --- <br /> ,��,���� s-- <br /> t ss nnni f.�vn�e S_ __ <br /> OawnreDue S <br /> PriM or Type Only - <br /> --r <br /> � � � _ oyae � �U�g_ ��Qi ��e,e.-� �aZa� �.�y-, � .� <br /> Owne� Madiny Audress C�ty Z�p Phone <br /> Sam�_ <br /> u1k. ZSF� — 18BZ <br /> Apphcant Mmling Atldress City Z�p Phone <br /> �n ' —_ <br /> DeSCnDc PrOposcd lVotk _�(LfJ� yf�Qfe tG�� <br /> � <br /> Prolect Address Id knownl �VO� J_ r�}���_ � <br /> Attach four 141 cOpies o� p�a�s ior oroposed wo�k� Draw to scale and nole Ihe lollowing as appllcable� � <br /> • PropPrry Lmes • Centerhne ot siree� � <br /> A Outline anA Elmensions ol ail eKisting and • Indicale North <br /> proposrtl s�ructures on Ihe lo� • Show any proposed qratling changes <br /> • E.isting and proposed ul�lAies • Show measurements � <br /> DO NUT WRITE BELOW THIS LINE <br /> PERMIT CONDITIONS O <br /> 1.All calls lor inspeciion shall be made 24 hrs.in advance-phone 259�8870. � <br /> 2.All work shall be perlormetl in accordance with this permit and current City of Everett Design and Construction <br /> Stendards end Specifications. <br /> 3.Call Location Undergrountl Service 4B hrs.betore you dig.TOLL FREF NUMBER 7-�-424•S5rJ5. � <br /> O <br /> � <br /> � <br /> O <br /> a <br /> AGKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees to hold and save harm� <br /> less the Gty ol Everetf Irom any and all claims lor Camages, costs, <br /> ezpenses, or causes ot acUon that may arise because ol insts'lation <br /> and maintenance of Ihe imUrovement or other righ��of•way use hereto <br /> applied lor and fur�her agrees to remove same upon notice hom ihe <br /> Approved for Constniction Date City and to replace publ�c pronerty damaged the�eby. <br /> FINAL INSPECT10Y Date ��� I�7�_ t <br /> ApDroved as Conslructed Signature ol Applicant Dale <br /> everett PUBLICWO?KSGEPARTMENT WORK AUTHORI2ED BY 1HIS PERMIT MUST BE STARTED WITHIN <br /> � t80 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> 3200CederStreet BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Everetl.WA 98201 CANCELLED BY THE CITY UPON ANV STOPPAG'OF WOFK ON THIS <br /> Phone:259�BBt0 PROJECT OVEFi 90 QAYS�UFATION. <br /> l7-�9-87 <br /> ��� 1� `�1 �r�ipA�'�'/lFn.i ��< <br /> � A2f2�{ — N�� <br /> Tj/E �occot�/.�j <br /> D��� ,��-,— �tccc�-,_� <br /> I,�c-na N i b ��YS Ti+AT Tt+i s fc'2 k��S%�'��`'�� �- <br /> �.-OT H-AS EXCE� M+'f �4l.LEY CF/- t'F Sn� �j�/ S T� <br /> �4 cck-S S A ni r� TrtL-1xEF-o2C-' i..ro u�(�tir�' c"�.�,�,r H;r,,p�s�,e <br /> M�-r' co� — su-r <br /> st� ��-,rt� MfkcM , --------- <br /> t N 155u�!$ �. t�t"tzM iT /t� �T 15 A ' /�l1'F-C� �'7 �/:T L 45�- <br /> j�_F,?i„ii �"'n�» /��An.�,��(. <br /> (�OC-1 VOLVMF K�nrO OrT ��O E�'Jf� S'T. ___.__ __".— ' <br /> WAtvT 'ro Si 6ni � � � i[� P.�'c yA����C�T�=�Tn <br /> � r�- AtiL /<'Sr�tc ; �.,' �tN�ti�O Cc�,e�, <br />