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� <br /> � <br /> � <br /> � � � <br /> m � x <br /> Q H <br /> � xH [n <br /> '�-~3zH <br /> Ky � � / <br /> 'C�] Ex-+ h�y Date����`� ��:�,��<<:��,�.,P..,�,��. ���2 <br /> �___ <br /> y �, � APPlicalion FUr ein�t J�.n� • _____�_ ._..- . <br /> � ya PUBLI� VI/ORK� PERMIT P°°;o;;°FeC°'e S—�r°�-- <br /> g ��s,A�o� F�,.N.,�, s_ <br /> ��' � TO POSTING �"'____�-°J' �,�.,,�:�.��� 5 3s%— <br /> z y � FriN cr ?YPe On�y ---- <br /> � z <br /> Hy <br /> g�' ����J�n� c' a�57" / �:a- �afluC--lj .c ����zr�� u>,u Si3'.5"-y�5'l <br /> H <br /> n ty (q Ou�ner Mad�rg Atldress City 7ip Phone <br /> � � � — `S"f' },� ,J — — <br /> H O C/� Applir,ont M1lailing Addre;, Gty Lp Phone <br /> ! !� V �-r� � <br /> Describe Proposed Work J�/�e�,��J�OSS �,S t� ]U � flL7� v/� S�__ <br /> ca �,�.� �`,�: ,sc- _��� — - <br /> , <br /> --_� c.��7�k. r R�,SS/�c. �/ �u c. �c�1L c.r;�ss C — <br /> - -- ��nc� -�a�'t ,��� i11 <br /> �_��—l�s-'� � �-, „-nc•r,- � <br /> rrolect Atldress(il knov�n) i i—r=�'�t----- <br /> ,1P.,�-�.h Ip�,�;�q�copies ol plans lor proposed work- Draw;o s^:dc antl note the followin9 aa;ipplicable: � <br /> • Properry Lines • Centerline nl s�rce� � <br /> • Oathne and dimensions ol all exisung antl • Indicale North <br /> proposetl strectures Gn ihe lo� • Show any pruposed gradm<� changes <br /> • Exi=�in� ,�nd proposed utilities • Show measuremeNs � <br /> 'w' ��_ D� O N�OT WAI�TF� NELOW THIS LINE <br /> �o� PERMIT CONDITiONS �1 <br /> 1.All calls for inspection shall be made 24 hrs.in ativar.ce-phone 259•8810. � <br /> �v' 2.Atl work shall be pedormed in a:cordance with this permit and current Ciry of Everet�Design and Construction <br /> Standards and Specilicalions. <br /> ' / 3.Call Location Underground Service d8 hrs.hefore��ou dig.TOLL FREE M1UMBER 1•800•424-5555. `��� <br /> �0 / / � <br /> '_, .�, � C���a.— � ,� aati- l/�Ir�c� �� -7-.i=B) � <br /> ��� <br /> '1 � <br /> -j C1) <br /> ►-� ' <br /> O <br /> oe9 �° <br /> �—� . __ <br /> 4 ' ACKNGINLEU(�aEMENT OF CONDITIONS <br /> � The undersignetl o.vneVapplico��-hereby a�iees tb hold and Save harm� <br /> -- . less the City of Everett irom any and all clains for damages. costs. <br /> J expen5e5, or cau5e5 O� aclion ihat may arise because ol installation <br /> and maintenance of the improve�uenl or other ri9h�robway use here�o <br /> i - <br /> ApprOv r onsir4e 'pn/,- _ . , Dat� applietl for and hnther agree5 to remove 5ame upon notiCe from the <br /> City and �o�p�ace public propei�y damaged Ihereby. <br /> ; - � %f �/�/� �fz�,��„� �/.:��-./.�� <br /> FINAL �NSPE TIObC��' D te <br /> ApP�oved as ConsirUCted Siynalure 64l�plicant Date <br /> everet[ PUBLICWORKSDEPAF7MENT WORK �U7NORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> � 3200CedarStreet 1B0 DAYS OF DATE PEFMIT IS ISSUED AND TH[REAFTER IS TO <br /> Everett,WA9R201 BE D!LIGFNTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Phone:253-BA70 CANCELLED [3Y THE CITY UPON ANV S70PPAGE OF WORK ON THIS <br /> PROJ[CT OVER 90 DAYS DURATION. <br />