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i <br /> � <br /> � <br /> , <br /> � <br /> Date_���Z��'> ������,.,���..,�•,,,m„ � J`�7� 4c7O <br /> Applic�.!ion fer ���u q�•N/ �((��ll '7S 7�j <br /> L ���� _—__ _ <br /> FUBLIC WORKS PERM17 ��,:�a��°° � - <br /> Lns��n�I Gee PaiJ S <br /> Print or Type Only or�����❑�� s <br /> ��� I��� ► � l��t �r32i2 t��dinor��i��� <br /> Own r Mniling Aad�ess C�ty Zip Phone <br /> ��i� _- �J��� <br /> Apphr.nnt Mailins Aadress Gty Lp Phone <br /> Describe Proposed Work _�(,,1,_J `� (--LJL, � � ! /�� L]2�f' ( � L;U /� _ <br /> Prolect Address!d Imowm �C/��� ����/C, ..� _ � , <br /> � <br /> Atlach lam(4)coples ol �:lens�, �proposed work• Oraw In swle nnA nnte the Iollnwing ns applicahle�. A <br /> • Proper�y LmeS • Cenlerline ol 5�reet ,A <br /> • Outlme and dlmensions of all existing anA • Indir.ate Norlh M� � <br /> proposed s�ructeres on Ihe lol • Show any PropOseA gradmg chanpcs ' <br /> • EK�s( ig anJ p�oposed utllllies • Shwv mAasurements � <br /> DO NOT WRITE BELON'THIS IINE O <br /> PERMIT COND�TIONS <br /> . 1.All calls tor;nspeclion shall be made " � h�s.In advnnce�phone 259•8810. � <br /> 2.All work 5hall be pPAormad in eccordance with this permit xnd currenl City ol Everett Design nnd Construction <br /> Stenderds and ipecifi:e�ionc <br /> 3.Call Locallon Underground Semce 48 hrs.be�oro you��g.TOLL FREE NUTABER 1•800•424•5555. � <br /> � � i ri:�.- i r. �,i�',�. i� r.� . , - , � � � I <br /> �l . . . .� . �!� .. . . . .. , . . . <br /> Lr; ��F{!_ �U'_!.:L. W�F.1:5 !1�:;( I_t.� !Uf, . � � <br /> i ,L1SE PUBLIC DRAINA6G SY'�TE�1 A� F'ROVIUED FO�, ' i ' , <br /> 6.�NY L[]T GRADC l'HAI�GES MUST BC Af`F'ROVEL' �Y ' ' � <br /> PUDI.IC �4(�RF�:' TtdSF'S ��tOh. H <br /> ?.tc:L"FF' CITi 1liLl"''!i CLEA(�I AT ALL TIMEEi. <br /> �3. TNiTAU_ WF1 F:,^, 1'��7%ES TO GFi/1DG AT TIIE E'JD Of � ' ' � <br /> ' i � vi/.,i .- r.l .� �- �. � � �� p f' . . �}r.r' ,��,�r• � �i-' , i I 'I I'r. �.ri � ; ' <br /> � <br /> � � <br /> ACi�N�1WLC[7Gf MLNI Uf CC�NDItIONS <br /> Th��undersi9neA oti�n,;:�r.pph4aN hi��e'Uy a9rees to holA�nU savc ha�nr <br /> — - I��ss Ihe Cdy ol Evei=lt Irnm any and al� claims for Aamnges ro�as <br /> p�pences, or causes ol ncUon that may nnse her.ausr ol inslall;d�an <br /> R and mamten�nce ol the improvemenl or olher n,ih1 �d�w.rv nsr� h��n�10 <br /> ����5�' � � ��`" Ppp6ed tor 8ntl Ii�rlhrl agree5 �o �P.move 9Bmr� �.q�nn nnprr hun�� t��,� <br /> Appro/ lor C��clion / / ! Dnte Cily and b replace pu�hc property demageA the�rl�o <br /> ; / <br /> FI��IAL INSPEC�,TIO � l /��� . •:� �!� f .��ic i l�f r' __ -. _. i !/'.,;':t�.t . <br /> Approvnd as Gonstru�:ted ,Sfynature ol Apphcanl ��++��' <br /> � WORK AUiHOR17En BV THIS PERMIT MUST 9E STPRT[D WILHIN <br /> evrrrtl PUBLICWORKSDL"PPRTMEN7 100 DAVS OF DATF. PERMIT IS ISSUED AND TNEREAfTEfi I; i0 <br /> � 3200CednrSlreet BE DILIGEiIiLV PURSUFD TO COMPLETION THIS FERMIT MAV HC <br /> Everel�,WA 98201 CANC[�.LEC :�V THF CITV UPON ANV STOPPAGE O�WORK ON TF�ifl <br /> Phone 259-H910 PRpJ[(,T OVCR���1 ��1'S UIIRAi1f1N <br />