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a � <br /> oate�J S�- 6'� - 3H_S -- <br /> v„ri�c w�,.e a�pX�/. ��T� <br /> APGlicatlon For o�ao onn� ._�LL'.�� /VoZ _ <br /> PUBLIC WORKS PERMIT Pubiicylmwef�e - -- <br /> Tme�ren d <br /> lefe�p0� Fee Pa�C S_._��_ <br /> Print or Type Only fl.�.�=s o�a S D= _ <br /> � �� �.,�ti,-. - �-> �y�z- �.��_'���_„v�. �s%�,�wa�� �5�.3'— �74 y <br /> �C� Mallfnq Addresa Clty '2i Phone <br /> P <br /> ��_ <br /> Apph t Malling Adtlress Ciry 2ip Phone <br /> 1 <br /> Dnevibe Froposed N'orN __ �� � <br /> ��T<� - W <br /> P�ojacl Address lil known) <br /> s/z� -- iny '' cr. _s._- — — � <br /> Attach lour(4�copies ol p�ens for proposetl work� [)ra�. �n�,:Ale and nole the lollowinp as applicnblr: � <br /> • Property Lines • Cenlerline ol siree; /� <br /> • Outline end dimansions ol�II eMisting arid D Indicate No�th ` <br /> propased siruclures on the lol 4 Shov�any proposed gradin�chanqes <br /> • E�isting and proposed ufili�ies • Show measuremenis � <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT(;ONDITIONS <br /> 1. All calls lor inspeclion she"be inede 24 hrs. in ativance� pho.ie 258•881 5. � <br /> 2. All work shall be perlormed in accordence w�th this permd and cmreid C�ty ol Eve�ett Deslgn and�onslruction <br /> SlanAards end Speclllr,a�lons. <br /> 3. �all Location Underground Snrvice 48 h�s belore you dig. 1'OLL FREE NUMBER 1•800•424•5555. � <br /> � S�D�Gl!�c.0, lrOizfj� G.UT•tt-� �i?�-r iliE�J fJZVD LlNdf'LC,CF,!/ O <br /> ,Q,d�/ .�9/�1,L��E� S 9�L /.�E �'i aSL:iJ h'�i' '"i✓E fi'r'i'/_iCr��ciT <br /> .5 C'<Sf L��r✓�"clqy /?i?��:�:1� . � <br /> � <br /> � <br /> ,� <br /> 4CKNOWLEUGEMFM UF CONDITIONS <br /> The undersignPd owneNappllcenf he:chy egrees lo hold nntl savE harm� <br /> — --- les3 Ihe Cdy ol Everetl Irom any r�nd all r.lalms lor dan�eges, costs, <br /> i / <br /> � e.penses, ni causes of eciron iha� may ense because ol instnllahon <br /> � _. � �L�y Ij6 and mamltn[ince ol Ihe improvemenl or othe� nghbol-way use hr.relo <br /> Approved lo�Conslru ie Det epplir.A lor end �driher egrees lo r0move sem= opon nohc. l�om the <br /> City end to renlace �ublic property dem��geA thereby. <br /> ' z�Z3 , :1..(� �; � �y << �. <br /> ..Th��c�.� . \ �.� � <br /> FINAI. INSPECTIO Dete 9�_.�'�'� -�^'� <br /> Approved as Consiructed Si nature ol Apphcanl Dale <br /> evrrrt� PUBLIC WORKS DEPARTMFNT WORK �UTHOHIZED AV THIS PERMIT MUST BE STAiiTEU WITHIN <br /> � :1200CednrS�reet 180 DAVS OF OATE PE5M1T IS ISSUED AND TMEFEAFTER IS TO <br /> Fverett Y/A 98201 BE DILIGENTLI' PUFSL'6'� TO ::OMFLETION. THIS PERMIT MAV BE <br /> Phonb: 259�BB15 CANCELLED B��THE CiTI PON ANV STOPPAGE OF Wf�RK ON THIS <br /> PFOJECT OVER 9C uAVS .��'RATION. <br />