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�, <br /> � <br /> Date 7/t��l n-,?� a�ni��wo,ksa�,�,�in �UU–' Z/,r2 � <br /> � �-X" / G.D'S�'YY <br /> Application For em� oea�.4 �—�� <br /> Pl1 ��LiC W�RKS P'ERMI�' PVUhtWorkSFee <br /> ,a�r�F�o s _ <br /> l.nss ApPI.Fee Paid S <br /> Print ur Type Only L����«o�� s a�— <br /> .�� c���;� C� ��aa _-i��oy���.� �_� �„� 9�zn�- <br /> Owner Mailing Hddress City Zip phone <br /> _�-X.� <br /> Npplic nt Mailing Address Gty Zip Phone <br /> De�crihe Proposed lVork �/✓I�,,t_�e�,���.�{/?�✓� �i:A,E, �-0/ �7� _ <br /> Protect Address(i� known) /�-7��� � �� � �� �G _ � <br /> � <br /> Attach four(4) copies of plans lor proposer v.�ork- Drav. t:>scale and nole the following as spFlicable: — <br /> • Property Lines O Centerline of sireet .y w <br /> !1 Outline and dimensions el ���� ���s��.��in,� .,; � �f Indicate �o-ih �� <br /> proposed strectures on the C� • Show any p�uposed grading r,han9es <br /> • Existing and proposed utiliY=�� • Show meas��rements � <br /> t:��� <br /> DG NOT WRITE BELOW fHIS LIN� � <br /> PERMIT CONDITIONS <br /> L All calls for insp�c�ion shall be made 24 hrs.in ad�»r�ce-pl�,or.e 259•881 O. �� <br /> 2 All work sha"bn perlormed in accordan�e w�th this Germit and current City oi Ev2rett Design and Construction <br /> Standards anu Sp::citirations. <br /> 3.Call Locatien Underground Service 48 hrs.tielore you dig.1 OLL FREE NUMBER 1-800•424•5555. aM� <br /> � <br /> �, .AII`;� ��I-IFlt�!�:�E II,I 'fl'E- DItTVF.I�JA'i CIJI I�iI.E]T E+1= AP'f'I-;OVFp �v <br /> ;�`! 'flil_ I='USI_IC i�lrRl:i Ii�ISF'FCTOi: . � . <br /> ;: U;:F FUti�L IC: DRA1:1�!(l�r �`i.':TE74 AS F'RCVT.DEll FOR llOWNSF'OUT: , <br /> ' .(-11VY LOl GFi�I)E: C!-I(-1NGF'S Mi_i;T i{I_ AF'F'RilVED E+Y TI-1E <br /> F��IPL:[C l�lOF'P;�� I�ISf''FiCTOF:. � <br /> I .I:'f_"_F.�' C:[l'`! STRF=L"I ._; �:]L.Er1hd (�7 F1L� TIME�' , <br /> : . INST/1LL W!-1TER FO;,'LS 't� GFfF1D� AT TNE EI.ID ��P COIVBTRUCTION � <br /> �r rini::r. �UF�F= DRIVGWA`(:, A5F COMf'L�TF_LY �'UliEi� C;F1'n�F � <br /> I �.fVING OIV 'fHCht <br /> ' �, i11V`( DFlll�'-1[�E TO TI�L. lUiiL' (1P�1) �]:D['lJAll.: ;dJLI F�FT. ��'.Fi'il:(1';i:l; <br /> fIJ 'flll (-1�T�I:or (l�_, � '�Jhl 1)I� �� ��: 1!'?I �f tihitl i�l f'I .. � <br /> ..�,� <br /> ACKNOWLGUGfP.1ENT OF C:ONUITIONS <br /> UI.�C� The underslgned or�nedapplicant hereby agrees to hold and save harm- <br /> less �he City of Everetl from any and all claims for damages, cosis. <br /> �1 expenses, or causes of action ihat may anse because ofinstallation <br /> �- �„ `�P_ ,y�I Y �!�8�n and maintenance of the improvement or other riyh�-of-way use hereto <br /> %L� JT�� ,� �. applied (or and tur�her agrees b remove same upon noticc Irom �he <br /> Approve �r Con�oi / i uate City and to replace publlc properry damaged thereby <br /> � '� -� r�c �� � <br /> /' �/ 1/.�� / <br /> / r <br /> FINA IN TIOId���" � Da� �� Z_���nn_� `�{ !��1� <br /> Approved as Cons�ructed Sign Wre Appitcant / f`r�lc <br /> BVErett PUBLICWORM.SDEPARTMENT WORI< AUTHORV_ED BY THIS PERMIT MUST BE STARTED 6'VITHIM <br /> � 3200CedarStreet 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Evereti,WA 98201 BE DILIGENILY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Phone:259-8810 CANCELLED BY THE CITY UPON �NY STOPP�GE OF WORK ON T�11S <br /> PROJECT OVER 90 DAYS f1URAT10iJ. <br />