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Date�r����� <br />Apphcnlmn Fo� <br />PUBLIC WORKS PERMIT' <br />Pnnt or Type Only <br />, , , .. .. „ , . p,��'/-� ��>>s� <br />n�.in n�.�i . _. t� U� L1�4'LJ�-�. . <br />i�ma�� won. ne <br />Lnt�ifee s <br />�...nn,�iro..ra�.�S. __ _ <br />�7 ., CSiI <br />� � . n�.. � `_C:' � <br />I G � , - , r�, � � - ��� <br />_ �i1��—��Z. ,.:'- ' - ��'cfi�'-�ti�il _ ., .i_1 •�� U ---- <br />OwnP.r M�i,ir; Ilr. un;.. l.n� �q, Phon� <br />--� u m (?- --- - - <br />ApP�icent C• iihng Atltliess Ctly LP <br />/�/'7 (`,� �/', L <br />Describe Proposed Work __ /1(A�� - `P� /—� . � -�-�4—___—_ <br />Pralecl AdA�ess UI knowN --� 1 GJ'�� !� d � /�.���i�C_. <br />Phone <br />.S. fS�_._ _ ___- ____ <br />Atinch lo .r IAI copies o� plans lo� pwposed work � Drew t� scale :mtl nrHe the following ns applicabi�• <br />�f P�oper�y Lines • Centerlme ol 5treet <br />Q nutline nnd dimr.nsions ol eli eeisiing entl • Indicnle North <br />p�oP�Sed s6llf.�lll�S Ofl IhA 10� �$hOW Pf1y pIOPaSPd yl��dinq r.l�ariq�'S <br />• E.�stmg and proposed utihlies • Show measurements <br />PEFMIT CONOITIONS <br />1. All cells lor inspection shell be made 24 hrs in ndvance - phone 259•8810 <br />2. All work ehall be pedermed in eccordence with this permlt and currenl City ol E �rutt Dosiyn and Construclion <br />Standards end Sper.11ir.etions. <br />3. f,pll locelion Undergrountl Service 48 hrs. before you tlig. TOLL FREE NUMBEH i-8�•424•55b5. <br />�( ��C��' A'/nG% �� E/"/ti^',5�� � �.2 �o�fr1✓ 3G��"_ <br />.3 (CT%+a�J7e�l� Cl�ji.eeYle/e.-� f7�.- C-C`yd-CCe�R�1�•�/'�� <br />" !1 <br />`�.� '���_ � 1 ga <br />Approved Inr Conslruc�ion ale <br />����..;r��<r:�..:��' s Je �,�� <br />_—,a�, �-�„ ,.--r�:� <br />�INAL IN. PECTION Uate <br />AUn�oved as Gonstrucletl <br />rvvrvtl PUBLICVJOI�iKSDEPPaTMF.NT <br />� 32�0 CeAei Strent <br />[verell. W� J9.^Ot <br />Phone.2:�9�NR10 <br />ACHMOV�LE�GEMEN� OF CONDITIONS <br />W <br />� <br />� <br />The undersigned owner'applicnnt herehy ag�ees lo holA and save harm� <br />less the Cdy ol Everett hom nny antl ali r.laims lor damnges. costs. <br />e�pe.�ses. or r.auses ol xclion Ihal mny anse 6ecause ol inslallation <br />and mamlenanca of Ihe imprcvemenl or other nghbobway usx herelo <br />eoplied lor and ��ithin Tgrpes In �emove same upon noUce irom R�e <br />City an 1 lo �ep',ice /rubiic pioneny dflmeqed Ihereby <br />� ,___ � � ,� — <br />Siynalure ol Apnhc�nl Dale <br />WORN AUTHORIZE� BV iHIS F'ERMIT MUSf 6E g7ARTED WITHIN <br />1B0 DAYfi OF DATF PERh11T IS ISSUED AND THENEAFTER IS TO <br />�E DILIGENTL� PUR;UE� TO COMPLfTIOM 7HI5 PERMIT PdAV BF <br />GANCFLLED 8� THE CITV Uf i�h �•rn� � if�!'P,-��1�;1� A^.'ilflfl i I^J llli`, <br />1'H�-�If( II)V�.RSIOOAYSI�IIHnIi�IN <br />