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7 � �/ <br /> Date 1 ���.�� (� r�no-cv�c,Fsv�,�„�i, �/j .�L�-- �/ - <br /> b7 C�7� APPIiCz6on FOf o��y �en�..�L�—IL^��__' . <br /> �,�x PUB�I� W�)�iKS PERMIT �°^;o,�;F��°�� 5 <br /> 9 H(~A ��.5 a�m r���r m 5_ <br /> o�i��«•o„� 8 ��� <br /> y �� Print or Type Only — <br /> �e c� <br /> H xl <br /> � �� _��?�)�►�2 ���I r���1��� r��, � -1�}P� QS� 7.�__ <br /> Hx y� wner Maihng Addres's C�ty Lp Phone <br /> py� _. . — -- ��Y���� <br /> � Apph�.�. : MBihm. ,., CiI� Ln PhOne <br /> H �g <br /> z �,~„3� DescribeProposerf Work �I ��--- ._ �(_L1 ����L(_L/ (�1 I���' ,�� <br /> � Hy — — — <br /> � <br /> H <br /> O C7 V� — _— — — — <br /> � �� — � <br /> y �� Prolect Atldiess Id knov+n� 52� � 2-3�=� Q,c-`P. L.�/. � <br /> - � Attnch four 14)copies of plans for pwpoS�A worh� D�av:to sr.ale antl note the!ollowing as apphcabie �� <br /> • Property Lines • Centerline ol sireet ♦^ <br /> • Outline and dimensions ot all exi���t�ng an�f • InAicale No�ih V� <br /> proposed 5trucWreS an Ihe lot • Show any propo5etl gradinq cY�anqes <br /> • Exislin9 and propOsed u�i�ities • Sh�.v: measuremeNs � <br /> DO NOT l'JRITF BLLOW THIS l IIJE <br /> � � OI� PERMITCONOITIONS <br /> 7.Ail calis lor in5pectipn shall be made 24 hrs.in adv.nce-nnone 259-8810. � <br /> 2.All work Shall be pedormed in accord'ance wdh this permit and current City c! Eeerelt Des�9n and ConstructiDn <br /> m � Standards and S�ecifications. <br /> � � 3.Call Location Untlergrountl Serwcc ne hrs belore you mg.TOLL FflEE NUMBER 1•800-424•$555. � <br /> ��� O <br /> ��� <br /> ��� � <br /> � <br /> � �- a <br /> �r <br /> � ACKNOWL[DG[M1tl ':7 OF CONDI710hl5 <br /> The undersigncd ownedapplic:�n; �veby a9rees�o hold and save harnr <br /> + — less ihe Ci�y ol Everetl Iwm any and all claims lor damages, cosis, <br /> / expenses, or causes o� action �hat may arise because ol inslallation <br /> — ��� ���`� �' ��/�� antl mamtenance of ihe imprOvemen� cr olher nght�ol-way use here�o <br /> � Y applieU br and lurlher a9ree5 to remove same upnn notice iran �he <br /> Approved for Con r --.ion �� Date City and to rep ci. puUlic propen 'ima9ed ihereby. <br /> "�`�`-� �=-r--� �„i I I QQ <br /> FlNAL INSPECTION Datc — — <br /> Approved as Constiuctetl Sip atme of Anni��;�nt Date <br /> rvr_mtl PUBLIG WORKS DEPARTMENT �NORK AUTIIORIZED BY THIS Ph MIT MU3T BE STARTED WITHTN <br /> 0 3200CedarSireet 1B0 DAVS OF DATF PER611T IS ISSUED ANO THFREAFTER IS .:� <br /> EveretL WA 98201 BG DILIGENiLY PURSUED TO COMPL[TION.THIS PERMIT MAV �E <br /> Phonr.:259�BES70 CANCELLEO BY THE CITY UPON ANY STOPPAGE OF'NORK ON TFIIS <br /> PROJ[CT OVER 90 DAYS DURATION <br /> � <br />