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/ <br /> �-,�-��� h'A - /o.� <br /> Date i,.�ni�, w,�.�ti��„��_�����7� <br /> Application For ���+n n.m • __�1. <br /> PU�LIC WORKS PERMIT °°°;�,W��°�°° : - --- <br /> �e.,�o�� F�w�,,,, s <br /> Baiance�oe S �O <br /> Print or Type On!y — <br /> ���r.?o �_.��,, �It� �-1D����� rr�� ��i�3 ��y�-�ai � <br /> OWnBr hlaJiny Addre=.s „iIy Lp Fhone <br /> �ppGcan� M,.diny AddrC55 Giy Zip Phone <br /> Describr. Pr����sed�York ����� S` `�� (,,,f� 1 `--1�/�L��—S�(�L�� <br />. ____ ' — ���_s-�_._ — <br /> — — _ � � <br /> P�oler� Pd7ross lif known) ''�z3 - /�9�-" r�, sc: L <br /> r <br /> nitrch tow Ia1 copres ol pl�ns for nronosed work- Draw to scale r�nd nole Ihe lollowinp a:epplicable � <br /> � �'roperty lines • Centerline o� slre.el /A i <br /> • Outhne antl dimension5 0l nll ex�sUng and • InAicale Nnrth �� <br /> prOp05ed 51nIG1urP5 on�he lot O ShOW any pioposcA 9ruAin9 changc5 <br /> � • Ezisting nnd proposed u�ilities • Shnw mpasun•in�nis � II <br /> DO NOT WHITE BELOW THIS I.INE O , <br /> � PERMIT CONDITIONS <br /> � � 1.All cells for inspeclion si�all be madr 24 hrs.m advance.�phune ZSJ•BB'I O � <br /> 2.All work shall 6e perlormnd in eccordance with this permit and current Ci�y W Everelt Design anA Construction <br /> Standards and 3peciliinlions. <br /> 3.Cell Location Undorgro ind Service 48 hrs.befoie you Aig TOLL FREE NUMBER 1•BOO•424•5555. � <br /> �i�, I�'�Ef� CiTy sr,c'fEi.l C'cEy�/ .9 T 9« T.rnFS O I <br /> ,S (/.J�E Pi/b'CiG lJ,E�AiN/!G6 Sy.�E?J FO.0 iP00�Tci/� I <br /> .I�vui�/-JPvvTS. � <br /> Fi. CU.�'d� G.v?E,C-' A�O S.iJ�i✓!✓c.0 .A.(:f" .✓�'iJ AND tIN�,�'�i.(!_it/ �� <br /> A.✓� vA�na� l��UST B� ��i°C/JlEU/�('6�F�iie%`D �� %iYf <br /> q,�.����.o,vr. O <br /> 7. A�v CH.aN�r�s To T.v� o.P,��Fa�.v, cu.�-B - G�' l��.s.- a <br /> B�Ano,�a���v By T�,�,r PvB��c ��r��.�c _T�o��c�oT <br /> AGKNOWLEUGEMENI .lF C(�ND�71UN i <br /> The unde�signeA owneVapplicanl hereby aGreee lo hold entl Sai�e haim� <br />, � - - � less the Gty ol Everelt liom any and a�l elaims lor damnpes. r.osts, <br /> / � eepen5es, or r,auses �1 achon Ihal may ariap brcPuse ul �nslalln�ion <br /> ` � p f��,�� � Ag nnd maiNennnce ol the improvemer9 oi olher n�,hl-obway use he�nto <br /> Z/L _ apphed lor nnd lurther ayrees �o remove same upon not�ce Irom Ihe � <br /> ApProv�Aor Constructi n Dale CdY�nd to rePlnce pul�hc prupertY Uaina�eA there'-Y . <br /> �, ,/�._ �,/ � , 1 <br /> . , I <br /> �� �.l� � ��_;; �i�_ , /� , �� � � <br /> FMAL INSPECJ N(�'" � Dale L�A� � �' -- � i <br /> ( . <br /> Approved as Gmsirucled SlgnaWre ol Apn'ic.•mt Dele <br /> PUBUC WORKS cPAPT.iv1ENT WORK AUTHORV[D 9Y THIS PE9AIIT MJST BE STARTED WITHM � <br /> ��vrrt9l 1B0 DAYS OF �AT[ FEHMIT IS ISJUED AND THEREAFTER IS i0 <br /> � 3200CrderS�ree1 BF DILIG[f'TLY PURSUED TO COMPI.ETION. ?HIS FEF�MIT MAV B[ <br /> Everett,WA 98201 CANCELLED PV iHE GTV UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone.259�8810 PROJECT OVER 9C DNYS DUFATION. <br />