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�a,�� ��---- <br /> PuolmWarksPcemit• � --- <br /> pIJ9.0eP1.x�-- —_ <br /> Date_� - 1 "c�:�=} -�� '�, . ,o 0 <br /> qpplication For Cub'.�Ch'�'k�Fea � �_-- <br /> �����I� Total Fee <br /> VNOR�C -- <br /> ����'� �l LessAVPLFPePaiOs Y� . ,V� <br /> g�mnce Duv g� <br /> ��� �� <br /> Print or l'YPE O�ly i �(ya- <br /> � j!}�� V,S. L- .� � � � L �-LV � =- <br /> ) � Zip Phone��rj_JS'iv <br /> !' �i t, IL1 f)/� � � r7�„ l 'Myilin9 Address City <br /> �� phone <br /> Cily <br /> Zip <br /> �j � Mailing Address / <br /> APPlicanl a j__�—�� <br /> �1 �.�_ L� �r- <br /> � ) � ��R�-n� r <br /> Describe ProP��sed Work .tYS-1- - � <br /> — --- � <br /> �-- 'f <br /> -- S.� �y0t0 <br /> ---�� � • � � <br /> i{knownl cale and note lhe tollowing as aPPlicable: � <br /> prole��Address( Work- Draw to s <br /> co ies of plans far P��Posed � � Genterline ol sireet <br /> Attach four(4) P � Indicate North rading chz��ges � <br /> S ProPertY Lines • Show anY ProPosed g <br /> o putline and dimensions of all existing a�d s Show measuremeMs <br /> proposed struc:��osed utll'Ries �\ <br /> � Ezistin9 and p�•" <br /> DO N07 Wal i E BELOW THIS�INE y�� <br /> �iona 259•8815. �ctior � <br /> PFRMIT CONDIT'�ONS ermil a��d c�«enl CitY of Eve:e!t�esign ���G° <br /> t All calls for in�peclion shall t�e�cordance(Withlh s pCe P n24•555.`. � <br /> 2. All work shall be PP!formed' <br /> Standards and Specilications. ou di9.TIiLL FREE NUMBEF 1•SO - . <br /> 3. Call Location Underground Scrvice 46 hrs. before Y � � <br /> �- <br /> f. <br /> ['i <br /> � <br />� � ^J <br /> � ti � <br /> ri �- <br /> � � �: <br /> G c <br /> �] f, <br /> O �:, <br /> ti ':. <br /> r�qENT OF GGNDIT�ONS r*] � <br /> ACKNG'�v'�EGG=� � r, <br /> lic3nt hereby ag�ee�u'holtl and save rosls, <br /> 7�ie undersigned ownodaPP and all claim��. for d�mages, 7 , <br /> ot Everett irom any yrise because of installation t" <br /> � less �he GitY use herel� '��3 �� <br /> ---_�_�— exPenses, or causes of actioovehment or other POU�'o°� nol ce irom the K �_ <br /> and mainten2nce ol the imP O _ <br /> � �/ / .�� �—/y �r aPPlied for and�ee P���9�fOPe�Yr�ama9Ed herebY• � r- <br /> ��/ . Date City and to reP � P. <br /> APProv for utruction � _ �1�� r,l <br /> ��` Z_lo�_.�� o��e � ,: <br /> � <br /> Date Vsi9nature of ApPlicant , STARTED W�TH�N � � . <br /> FINA INSPECTIO' WOR�: qUTHORIZED BY THIS PERMIT M.!ST BEc q,..'IT N1AY dE � ,�. <br /> APProvedasCon:. 180 OfYS OF DATE PERtATO�COh�UE�InNLTHI.��pEAM'TER IS T� � . <br /> everelt PUBLIC WORKS DEPA <br /> TMENT gE DILI iENTIY PURSUED aNY 5���'��'FGp (;c WORK ON THIS <br /> 3200 Cadar Street �ANCFI.IED BY THE CITY UPON . <br /> � Ev?rett.WA 9820� f�ROJEC� G'J[R 50 GA1'S DURA710N. <br /> Phone� 259-8615 <br />