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�BfQ�p.�y� � • a��i�c Wn.�e Pnrmn• <br /> / y n <br /> Appllcet!:,n For Piep Deo� � __V _-Jl�.— <br /> PUBLIC WORKS PERMIT °°°°°W���,��� <br /> Tot�l�ee � <br /> Leaa�oo� feeouE S <br /> B�I�nreOue = <br /> Print or Type Only <br /> -���tr,�v .�a�•�e C�tire �b[�6�� C,n.o a.3�a.-/SG /Jl� ��>�� <br /> U ner Meilinp Atl •e;s �— � City Z�p Phon <br /> 1�Ci.� > �`� - S'��'�5/ <br /> Aoplicant Meiling AtlAress City Lp Phone <br /> DOa.:ribe Proposed Work __�E3,�,�a�� v t�u4.� �F�. <br /> — — // yn— [cr z vf wc, y'2 � I <br /> Prolect Add�ess�il known! _. Q7` '" �Q� ^ S� S E _ � <br /> Attach lour(4)copies ol pIAn9 fOr proposed work� Draw to scale and note the lollowmg as appl+cable: � <br /> • Prof=rty Lines n Center6ne of stree� //1 <br /> • Outhne end dima�isions of ali e�isting and • Indicate Norlh V� <br /> propoSeU SUuctures on�ho IJI O Show eny propused gratlinq changes <br /> • EMiSiing anA proposed uldilir.5 • Show measuremenls � <br /> DO IJOT WRITE BELC�W THIS LINE O <br /> PERMIT CONDITIONS <br /> 1. All calls for mspection sha I be made 24 hrs. in aAvaece � phone 259•881$. � <br /> 2. 411 work shell be perlormed In accordance with Ih:s permll �nd current City ol [verelt�esi9n and Construclion <br /> Standards end SpeciLCetio�s. <br /> 3. Cell�oca6on Underground Servlce A8 hrs. before you dig TOLL FREE NUMBER 1•B00•424•5555. � <br /> 7• S/oEw/Jc.t� Cu�� ¢ C.ull'E. e /s NEc✓ � t{NOAn/9C�El� O <br /> /f,✓y OF /T' Ti/b'T /S t)9in�96E'U S�'9c c dE� iQF,iJL 9C&d <br /> !�f/ TNE APs�:cH.✓T, ■ <br /> r <br /> 5 LOT Sii'Aac BF G,Z/JOE�J s� �7t nJoT 7o IMPr9CT N <br /> TNE d'�/�t'.e0lI.VOi,(/Lr �'�'c�/�E�c'T.ES GJ/%N iPA/y!t/1�TE�' � <br /> .('uci�f�`• � <br /> i <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owneqapplicenl hrreby egrees lo holtl anA snve harm- <br /> -- less the Gty ol Everetl Irom any nnd all deims for tlamayec, cosls. <br /> erpenses, or causes ol actlon Ihet may erise becauee of installnhon <br /> �����.a,���= �O�j96 end mnmtenance ol ihe improvemant or other right�obwey use hereto <br /> epphed lor and �ur�her egrees to remove snme upon noUce ��om �he <br /> Approved lor onstr uon � � City and to repl�ce pubGc property dernegeA thereby. <br /> 2- (2.� �� � �1 ��-_ <br /> FIMAL INSP CTION Dnte - <br /> Appruved as Consiructed Signalure ol AnPlican�` Da�e <br /> evrmtl PUBLIC WORKS DFPl,1?TMcNT WORK AU7HORIZED BV THIS PERMIT MUS7 BE STARTED WITHIN <br /> � 3200 Ceder $I ee� 180 DA'/S OF DATE PERMIT IS ISSUED AND THEREAFTEF IS TO <br /> Eve�etL WA 9B2(l: BE DIIJf-C V rLy pURSUED TO COMPLETION. THiS PERMiT MAY 8�-. <br /> CANCELLED BV THF CITY UPON ANV STOPPAGE P�!'+ORK ON 1HI`.. <br /> Phone. 259�9815 F'ROJCCT OVER 90 DAVS DURATION. <br />