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i <br /> ..� �r F,�un�rro,k5 Pmmn .. <br /> Date � ������ n�.p� . _��i'�o�.�J`�(�i� <br /> Anplir,ation For <br /> --_—_—_._ _._ . __. <br /> pUBLIG WORKS PERMIT "°°"`"'°`"_"` _ <br /> H ,o•,�F�� 5— <br /> xr� _..:,.:, ��,.�,:,., s_. --- <br /> �a y �,., s _ _— <br /> ��H Print or Type Onl, <br /> 9Hxcn <br /> �-�ezn 1��1f�1 �i�cr�l .%/ 7 — �_�C�" C,��S1PiA;'� �,•"i r��(7 / �w5C1= ZS/7 <br /> H:U M�JmyA<7dress City Lp Phone <br /> Ownei <br /> � H'�J / <br /> enH _NOU �IGO1 �(' tT�G ��'�'_�:�.�1����' Pno�e <br /> �i p� App6can 61�ibngAdtlress City �, <br /> Hl7 <br /> ° �g _—��cL�_�:�_1U_��tl����t�1�1�_�io� — <br /> f-I L�i Describc Proposed Work <br /> G]V CJ <br /> � N� _--__ _ � ii <br /> � <br /> ~ —__� r" f— � <br /> � C y Prolect Atldress.d knowN '�/� --�� _� ---�--- � <br /> tTJ L'� i.,�.�. i � <br /> z �� Atlach four 13i coU�es ol Plans fo� p�opos�d������- �� n� �� J•� :, �d notr Iho follovnng as opplir,able � <br /> y O Uj • PrOPerty Lines • Cen�erlme o�;Ireei ♦^ <br /> • Oui�i��e and d,mensons o1 au e��snng ;;ntl • I��A�r.atn Norih V� <br /> moposetl SVucture5 on ihn lo; • S��ov+ any propOsed yrnA�n� chan9es <br /> • Exi5lmg ;lnd p�oposeA ubldiCS • ShnW ntCBSuremenl5 M <br /> W <br /> DO FJO7 V,'PRE BCLO�7 THIS LINE � <br /> PER�d1T CONDITIONS <br /> � t.Ail caiis!or inspection shall be matle 2a hrs.in advance�phone 259•8810. � <br /> ' �'�' 2.All wnrk shall 6e pedormed in aCCOrtlance wi�h Ihis permit antl cunent City o�Everetl Desi9n and Construction <br /> a� Stantlardsand:pecifications. <br /> 3.Call Localion Underground Service 48 hrs.6elore you dig.TOIL FREE NUMBER 1-800•424•5555. � <br /> t� ~' L O <br /> � � � � .,r_�: /�''!'/iy % ��/ �!=GiC.ii�F.!i <br /> ( C/h�.%� C-�-,C'� -5 / �- / <br /> // / /' �w <br /> �1/.. � <br /> - _ .� ,; <br /> ai.� - _I <br /> �.�w � a <br /> _.s �, <br /> �CKNOWLEDGE64[NT OF CONDITIONS <br /> 0'� <br /> ' 7lurundersin���'�lmaner/applicanihercbyag�ecstohotdandsaveh�im� <br /> — -- —-- less Ihe Cdy of Lverelt Irom any anA all claims !or Gamages, cosls, <br /> expense;. or causes o� action ihal may arise �ecause o� installation <br /> and main�enanr,e ol lhe unprovemenl or other nghPof�way use herelo <br /> • appliad for and lurihci a{�rees to remove same upon notice Irom �he <br /> Approded lor CenSirucli0n Date City antl to repince public property dama9ed Uiereby. <br /> FINAL INSPECTION ���� - �a�e � <br /> ApProved as Constru-ted Si9nilwe ol Applicanl <br /> WORN AUTHOP.IZED BV THIS PERMIT MUST 9E ST1IRTED WITHIN <br /> �.��.��q� PUBLICWORKSOEPARTMENT 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTEFi IS TO <br /> � 3200CedarSUeet BE OiLIGENTLV PURSUED TO COMPLETION. TliIS PERMIT IdAY BE <br /> Everel:.WA 99201 CANCELL[D BY TH[CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phnne 259-8810 PROJEGT OVGR 90 DAVS DURC.TION. <br />