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Date�%�.� <br />Apphrnlion For <br />PUBLIC WORK.S PERMIT <br />Print or Type Only <br />nt <br />r <br />ng <br />Mading AAdress <br />Cdy Zip <br />� ,���� .,.,. .,.... .�=J�� - /C�7 .' <br />Pei�� Pnn� . _ L� �:_/ ���i b! <br />/ —_ ,—' <br />Puhl¢ Wer4� I�e - . .. <br />Tnitl ipn s _ <br />1 aaS lnpl t�e P�U s <br />e:,�.����n��. 6� -- <br />�! � <br />Phont <br />PhonP <br />Descr�be Proposed Wo�k _�'�Q14f�.lYf����F1�l�L�/Qili�--���-+�=M'--�4.� —_ <br />Projad Address U� known) — ��P � �D��� „fF _ _ ___ _ _ <br />A�lech loUr (4� rnpieg 0� plans lor propused wom � Draw �o sr,dr� ;�nd nnlc I�u� Inunwinp ns Appl¢abi�� <br />• Prcperly Lines • Genterline ol slreet <br />• Oullmn qnd Aimen9wns ol all ewisting �nd • Inditpic Not�h <br />proP�`.Pd siruc�ure9 on Ihe lol • Show any prnposeA yradmq cr�any,�s <br />• Ear,lm;7 and propo�ed uuiili<•s • Shnw ineasmr�menls <br />PFRM'T CONOITIONS <br />t. All cnlis lor inspection shell be made 24 hrs. in ndvance � phnnr 259•BBi 0 <br />2 All work sha I ba peAormed m accortlencr, wIL� Ihis permd antl r,urrent Ciry ol Everett Des�.7n and Const�uction <br />Slandaitls nnd SpedM1ce�ions. <br />3. C�II Location Underground Service 4B hrs. bnfore you dic� TOLL FREE NUMbCR i•8�•42$•5Sb5. <br />�.�1Ny TiZ�S'S D�' ���G�7T�fi0/!� T�%f' iSN Dc7[t/�t/ GNJ Ti.'.-S <br />Lr77 SNAtc d� �c'�'�,-,uv,cl� Ce�inf'�Gre�yi ,s�,✓v ,✓pT <br />/i.s����� n.dro �.T� ���v.✓.n�E L �� �S _ -- <br />i <br />� - �.� a3 8B <br />�,'�� <br />Ap�in•.��•il Inr i. �uciwn DN�r, <br />� , � ��� <br />FINALUNS .(, Da�e <br />Approved a5 Conslruc�ed <br />�vr���lt PUflLIC WORKS UEPARTMEN7 <br />� 3700 Cedar Strer.l <br />Fve�rn�l. WA 9A201 <br />PhnnF: :59�9A10 <br />,� �.,i� �wi [ i,�,i r.,E ui �,i c:�,Nu�n�,�,s <br />W <br />� <br />� <br />� <br />Y/ <br />O <br />a <br />� i.. ��� �".. ��.i���� I owner/apUli��'�I heieby ayrees to hold and save hanm <br />�,, u��� ��i, oi Evarelt fwm nny end all clam�s lo� demqges. ,:o.Is. <br />r.pens.•s �.� causes ol Flclion ihal AIBy 8119P, hPC8U5C ol Infi1:1121i0n <br />and main�enanr.e ol the impwvemanl or olher rignrol�way use :�e�eto <br />,q..�l�ed Irn and lurlher agrees �o remove seme upOn nolice I�,om Ihe• <br />C�ty ,and 1 Nplar.e p hc properly damaUeA thereby <br />���`"���¢�r_� i�--�3-88 <br />',�nn:nure nl Applicenl Date <br />WU�IM. AUihiORIZ[D flY iHIS PERMIT MUST BE STARiED WITHIN <br />7t3f DAVi OF DATF PERMIT IS ISSU[0 AND THEREAFTER IS TO <br />BE DIUC "NTLY PURSUE7 TO C011PLETION THIS PERMIT MAV Bf <br />^.PNi;FL t( D PV iFiF GTV UPON ANY SIpPPAGE OF WORK ON THIS <br />S.FJ11 C�I UVFR 9� n4Y,i UURAiION <br />