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� <br /> � <br /> � <br /> � <br /> I <br /> I <br /> Date� 'Iq-�fi� r„m��wo,�,r�,��n. �/�[ l �__ <br /> Applica�ion For nm� nem . � _�71'.J.Z.__ _. <br /> PUBLIC WORKS PERMIT �°�°,;;,:;�`•� : --- - <br /> �e.s eoM far Gn�n S <br /> er�a��.o�� S Z� <br /> Print or Type Only — <br /> PRrnn pn �D��'�, i7.� 7 / �lE (�7'~Gf' �13:11 Z �P�1J�7°Nf� 7��5� <br /> ownerJ Maihng AtlAress City Zip Phone <br /> Sa n� e _ �'�5 - .3 9Q l'� -- <br /> Applicnnt Madmg AAdress GIy Ln Phone <br /> Describe Proposed Work nj�t+�S_rnj�yy��i�INlp �Q.r —' a-c�/���f/,� [� <br /> _, � <br /> Pro�ac�Adtl�nss pl knownl — / �� — I�D L.PL , .S.E ___ � <br /> � <br /> Altech lour I�) copies ol plans for Nroposed work- Draw lo scale and nale tne lollowlny as apphwt�lP � <br /> • Property Lmes • Centedine ol slrcet ♦^ <br /> • Outhne und dimr+nsions ol ell e�ishng nnd • Indicate Nor�h �� <br /> prOposed �;Vuc�ure5 on Iho lol • Show any pruposetl grntling chan9rs <br /> • EMisY�ng and proposed uliLties • Show me25urements � <br /> DO NOT WRITE BEIOW THIS VNE <br /> PEFMIT COND�TIONS O <br /> 1 All calls lor Inspeclion shall be mede 24 hrs.in edvance�phone 2b9•88�0. <br /> 2.NI work ehell ba pedormed in accordnnce�.vith�his permit eud cunent Ciry of Everett Desi�n nnd Consiruclion � i, <br /> Stenderds and Speci�ications. ' <br /> 3.Cell Locatinn Underground Service 4B hrs.before you dig.TOLL FREE NUMBER 7•000•424-55F.5. � <br /> Li lii1. I UI�.�. I � . .J;4�1 !: ; r;:Jl I i. � Ul�. � O <br /> 3, I.I;E r'UHLIf GRAII�If�l.li: SYS7";_I`1 A5 PFOVLI�FD FUi <br /> ' IY LL'T GkAllc C:HANI;ES MUCiT I4F. AFPf'fJVE:D C+Y � <br /> �I,l_TC WORI� S TN9PEGTi]R. <br /> lf' CITY STREI:T; CLF_I1N AT fiLL. tII7E5. //\ <br /> .>;TAL I_ WATI=F�. F?�xFS r0 C,F•r1�h� �7 THF Fhll? 01 �/♦ <br /> � ' � � <br /> a <br /> nrr;N��vu_n�;nni_Nr �x r�Nnnion:s � <br /> 1 he�untlnrs'iynepd ownei;apPhc:�nl hereby agrees to hnlA and save harm- <br /> � b•�-,s the City ol Everetl Iro�n xny anA all claims Iqr dmm�ges, cos�s. <br /> r�.�,enses, or causes ol achon Ihal may Arise because of installation <br /> �� L� /�Xy and maintennnce ol Ihe unprovemenl or other nghPol-way use here�c <br /> U V A�p�,�d lor nnd furlher ac rees lo remove same upor nolice Irom Ihr <br /> Approved 1 onslruct n_ Da�e Cily an ro replace pu 1� P�rty damaged Ihereby I <br /> �'Cr.=�,�t ES��'�Y � ' .1-��� / l D �' <br /> FINAI INSP[CTION ' Date � � /`� y�C] �. <br /> Approvetl as Gonstrucled � ig Iw A p�a Date <br />'� ��vF+rrlt PUBLIC WORKS DEPARTMENT WORK UTH RIZFD BV THI ERMIT MUST BE ST�RTED WITHIN <br /> � 3200CederSlreet 1B0 Y F DATF PERMI IS ISSUED AND THEREAFTEI7 IS TO i <br /> Evarett.WA B8201 BE DIL ENTLV PURSUED TO COMPLFTION. TNIS PERMIT MAV B[ <br /> Phone.759�BBi0 CANCELLED BV THE CITV UPON ANY STOPPAGE OF WORK ON TIi15 <br /> PROJECT OVER 90 DAYS DUI7AT10�� , <br /> I <br />