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���-'7 , ..,�, w...sr«,m��. _f_� <br /> Date�� � � � c2�1 /i ��_-- <br /> �� :n oeoi • _:1_-i_.f�� <br /> n�na�:,00�� �c� ----- <br /> PUBLIC �VORKS PERMIT °"°T:,,:���`°° s <br /> t nsR�nn�ine Va�n � — ��" <br /> Pn�encr pu� 6 <br /> Print or Type Only <br /> �-in�i�u r bt���/11� �i� /Q�¢�L SL ��/li�-G� ���3 � �i�-.`��f <br /> �,N�y� Meiling Addrese —�— C�ty Lp Phune <br /> ���� Ssr�'� l�'att' /� �- -�_s�' C�/l�'� ' `>8� �����'.I <br /> Applicent Mailing Atldress Gty Zip Phone <br /> Deecribe Proposea Work ���.c�.[[?! �l'�F <br /> - - /� --- W <br /> I'ru!ecl Addreae(il knoW�) —a�1--�—u���—L� - � <br /> �� <br /> Attar,h low 141 cop�ee ol plena for F roposed work� Draw to scole and note Ihe lollowing e6 appliceble: � <br /> • Properq�lines • Cante line ol streel <br /> • Outline antl dfinensione of all eeisting and � Show anNproposeA 9raAing chnnyes <br /> pfOp09Ed B�1uC1UfBS O�(hP. 101 � <br /> • Ezislinr�enA proposed utililir.s • Show mensuremenls <br /> DO NOT WRITE BELOW TH�S LWF /� <br /> PERM17 CONDITIONS � <br /> 1 All : tls lor in9pecl�on sh211 be made 2� hrs in ndvnnce� phune 259-8815. � <br /> 2 All work ehnll 6e perlormed in xcc�rdance wilh thls p��mil snA r,urren�Gity ol EvereV Orsiyn and ConsVurtion <br /> Stnnderds nnd Specilications � <br /> 3. Cell Locelion Undergrountl Servica 4B hrs. belore you dlg. TOLL FHEE NUMBF.R 1-A00•424-5555. <br /> 7� `/—.�7- .a7 O <br /> /'c/r�� i!' %��1�'�s rc��c v,,,� .c 8% i'.�,,,,�:f�l� <br /> _�/ �' � <br /> � <br /> O <br /> � <br /> ACFNOWlED6[ '-1(Ni �`-'� �:��Nf11fIONS <br /> ihr�u+drrvqni 1��wnnr:a�pl�cAnl herPl�y ayniF+S to holA and snva ha�m- <br /> ___. .---_. . . . - � - i,�;,. In�� C��y �d Everett Irom any r.nd all cla�ms lor Aameges. r.osts. <br /> e•{:enses. or causes ol ac�ion Ihal muY Bn80 bv:cau<<+ ol �nslalldbnn <br /> end meinle,nance ol Ihe improvPment or othe� nn��� ^'�".,�� ����' �,r�r,ia <br /> _ appl�ed lor end lurther agrees to romova seme ��i�� , � ' � �� ��^1° t� �' <br /> Apnro�e�l io� Cnnsi�u�t�o�• �a��� C�ty end to replece public property damaqed Ine�r�i,�. <br /> FINAL INSPEGTION Dale ----- ��,�i�, <br /> qpprnved as Conslrucled 91gne�ure ol Applicant <br /> WORK AUTNORIZED BV TNIS PERMIi MUST 8� 51ARTE0 WITHIN <br /> �.��,��.i� PUBI IC WORKS DECARTAIENT 180 DAVS OF DATE PERMIT IS ISSUED AND THEREAF7ER IS 7�! <br /> � 3200 Ceder Slreel BE DIUGENTLV PURSUEU TO GOMPIf TION THIS PFRMI� �AAV Hf <br /> Ev�r�ll WA 99201 CANCELLfD BV THE CITV UPON AN� Slri�`PT�If U� W(1I7".UN 1HIS <br /> � �I�.r�n.� p54�Pn1(� � �qp.ICCTOV(�7 `�nUAVSDUPAIIUN <br />