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Gate���' <br />AppliCntian For <br />PUBLIC WORKS PERh71T <br />Print or Type Only <br />Mxiliny Address <br />c�iy z�n <br />�n w� o — <br />Apphcnn� Madm� Addr�ss Gly <br />D�escnbr. Proposed Work <br />•�� � . <br />r�,�ni.� w,. .. r..,,,., . ��,'1 _ . _ � _ _ O� <br />einu n»�n . _���-iZEj�_o'-i.l_�%L <br />n„ni�r Wmws rr� <br />tniairr� 6 —. <br />teef Anl�� fnr Pan1 S <br />Beie�crmi� s �—� <br />Phonp <br />Lp Phone <br />Prolc:� n^dress lil known) �� ��— �� � t/� I'[ . �E. __ _ <br />9� 1���-1r1„�. - <br />AttAch lour 141 ��O�Fs ol plqns lor proposed wnrk � Draw In srale and nole Ihe lollowing as applica6ie� <br />• Pronerry Lmes • Centerline ol slrert <br />• Outline and dimenslons ol nll e.isl�n�� and • Indicnle North <br />proposed strur.lures on �he lot • Show nn� proposeA yrad�n{� rhanpes <br />• EMrehng and proposed uhhlies • Show mcasuremrnts <br />PERMIT CONDI110NS <br />1 All calls (or Inspectlon shell be mede 24 hrs. in ndvence � phone �59•88i0. <br />2 All work shell be peAnrmed In nccordance with this permit nnd currem Cily ol Everetl Design and Gonstruction <br />Standerds and Specllications. <br />� Cnll Loca�ion Underground Servlce 4B hrs. before you dig. TOLL FREE NUMBER 1-800•424•5SS�J. <br />� <br />; <br />(/5� �ir''ASH FrioC.Cs i�'�' �('uOF ToN ,/,kru�qj Sf 'ric�� J <br />i <br />�i"O�/7 ���Fl� �f'aT- f,�i;�",t � - i = , ,,, ��,� <br />�� .`A,t�cn cu/ � - lo- ��fh^ . <br />� ' + : �� �iLC •S/1'�ll. r'+�� i! .�,�, . � ; . � .. � <br />n�� r', �'i- , � . n� , ,. � <br />�,-�_—.�.. _ : �� � <br />1 / � <br />- o� � t� <br />ApproveAfi�ConBru li n � Date <br />% � <br />���,i'// /<,� � /, <br />flNn`I S ECTION � �— Dat <br />Apn�o�cA as Gonstrucietl <br />rvr�vt� PUBLIC'NORNS DEPARTMENT <br />� 3200 CetlerStreet <br />Everelt WA 98201 <br />Phone. 259-BBIO <br />7'r r! �I,i . >� �"<' <br />ncrrd�nvl � I�af 1.4f N� n� ('.�mlUituiN9 <br />W <br />� <br />� <br />� <br />O <br />♦r^ <br />V/ <br />O <br />a <br />I ��r undersil���'cl om�m•i/nPPh�:nnl he�eby ayrees Io holcl and st�vr h.��m <br />i���.s Ihe CAy o� Evtarett Irom nny and all claims lor damnges, r��sl•. <br />rrprnsea. or ceuses ol nrlion �hal mny ense becTuse ol mslolltd�nn <br />and mamlenance ol the improvement oi other riyhl�ol�way usP � c���i�� <br />applied lor nnr! lu�lher egrePs to remove same upon nolice Iron+ U��� <br />Cdy and lo replaCe pubP^ �: opeily damayeA thereby <br />', � <br />, <br />� � < ;�- � <br />:y/lt'r,-••, u� �1r'�'��'� .�/�;�,, i <br />Signeture ol Apphcant ���' <br />WORK AUTHORIZED BV THIS PEFiMIT MUST BE STARTEO Wi���i��� <br />180 �AYS OF DAIf PERMIT IS ISSUED AND ?HEREAFTER 13 tu <br />BE DILIGENTL� PU�•3UED TU CCMPLETION THIS PERMIT MAV Bf <br />CANCELLED BY THE CITV UPON ANV STOPPAGE UF WORK ON THiS <br />PROJFC.1 OVER 90 D�VS OURATION <br />