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� � <br /> H <br /> �y� <br /> �� � .. . . . . . ... <br /> .3 ^t1 � `� `i <br /> � CA � Date`�f o�'(1 ( a„oi�cwo��.aa� • O � /'��7Y <br /> H nim, o��oi . ����-F—. - <br /> SL �:� ApPlica�ion �or :•„pi,cv�anxl.:c �-�—*-'_-'—�"�- --' <br /> t+l y <br /> ��g PUBLIC WOF�KS PERMIT ,o,,,�o�, >_ _ <br /> Less Anul Gne PnN 5._. <br /> �y � '7 —i�� <br /> liaianr.eo��. F ! L-� <br /> a H� Print or Type Only — -- <br /> ty F3 <br /> (�i� y <br /> i <br /> g�y (�►�r�'� �' �� >>�`'�T �-� 5 '���rz� 9-��'� l ���' , ��0 3 <br /> ��Owner / Mailing Address City Zip Phone <br /> �o� - — --- �=-�-1 -�33`� <br /> - - Applicant Mailing Atldress Giiy Lp Phone <br /> /7 �I-f1 ��i // '71 f)�( <br /> " Describe Proposed Wrrk �� � �� � ` -+--�.-�-- �'"�� `�---- <br /> J <br /> W <br /> _ � , - � <br /> Prolecl AtlAress(if known) .�z�.7 " .2.j ��� !i< �<� . �% __ <br /> A��ach tour(41 copies of plans lor proposed wo�k- Draw to scale and no�e lhe foll, �ny as apUlicable�. �� �. <br /> • Property Lines • CenlerGne ol street � <br /> • Outline and dimensions of all existiny und • Indicate North <br /> propcsed structures on ihe lol • Show any proposed gratling changes . <br /> • Exirhn9 and proposed utilities • Show measuremenls AA <br /> fe�' W <br /> �� DO NOT WRITE BELOW THIS LINE <br /> '�' PERIdIT CONOITIONS O <br /> '�1 L FlII calis for inspection shall be made 24 hrs.in advance-phone 259•SS�O. � <br /> 2.All work shall be pedormed in accordance with ihis permit and current City of Everett Design and Construction <br /> ' ' Standards and Specifications. <br /> � 3.Call Location Unnerground Service 4B hrs.before you dig.TOLL FREE NUMBER 1-800•424•5555. � <br /> 1 � <br /> � � <br /> 1_I � <br /> �-� O <br /> _� <br /> _� a <br /> _� <br /> �- <br /> _ ACKNOWLEDGEMENT CF CONCITIONS <br /> :9 The undersigned owner/apGlicant hereby agrees to hold and save harm- <br /> — less the City ol Evere�.� Irom any anc all daims lor damages, cosis, <br /> // : � expenses, or causes of 2� � .� that may arise because of installation <br /> ,�7( /� L / ,// /-�/ emd maintenance of the im,�n:ement or other right-oFway use hereto <br /> %!l'L/ �l�cY- �=�' r /� ' <br /> applied for and iwther 2 .rees o rerrbve same upon nolice Lom the <br /> Approved for Construct�n ����e 1 Ctl�ai�to repla�n6Fc �uf��1y ma9ed Ihereby. <br /> � 'l l� 1� �— / , � _ ��i�7' <br /> fINAL I��JSPECTIUN ��� ��a1e � �/� . � �%�� '� /��� �`f' <br /> ApProved as Gonstructed '�SJpa u e pf ppGc nt � Date' <br /> ev�•rett rUBUC WORKS DEPARTMENT WORK AUTHORIZE6 BY�i I EYiMIT IdUL'i BE STARTE� WITHIN <br /> 0 3200CetlarStreet 180 DAVS OF OAfE PE�MILIS ISSUED AND THEFEAFTER IS TO <br /> Everett.WA98201 BE DILIGENTLY PURSLl��TO COMPLEi ION.THIS F'ERMIT MAY BE <br /> CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phona:259-8810 PROJE T OVEfi 90 DAVS DURA710N. <br />