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, <br /> � <br /> � <br /> � <br /> i <br /> Date�!�-.3 `�� ����,�wo,..PwO,m[,,7 ]1c98 —]�6�9 <br /> Application For e�nv Deo� • �liS./����!...7_.. <br /> PUBLIC WORKS PERMIT °°�;oW���`•� :_ _— <br /> �.,,>�o� ����.,,� s /'� <br /> [lalflnfn DU! .S ��+�� <br /> Print or 7ype Oniy <br /> P.a��c�� � �.�I� 1�� �� ��rn�� �z S�5:�nG <br /> Owner Mailin�Atldress Cdy ip Phone <br /> �mP_ <br /> Applreanl Mailing Address City Z1p Phore <br /> Describ�f PropoSeA Work ��.�� ���11._�,��_ �_. _ <br /> Projecl Address lil known) Z O�/D �-�' �L•S�, _'____ '_ ____ � <br /> � <br /> Attach low 14)copies ol plans lor proposed •dmk� Draw lo scale and nole ihe lollowing as appl�cahln. � <br /> • Property Lmes • Crn erhne ol 51reM ♦A <br /> • Outline end dimensions of nll ezlsimg antl • InAicite Nnrin v� <br /> proposed StruClures on the lot • Show any proposrtl yiadin��r.hanges <br /> • Exi5ling nnd propose 'utililie• • Show rneasuremenis � <br /> UO NOT WRIiE BELOW THIS LIN[ O <br /> PERAIIT CONDITIONS i <br /> 1.All rnlls lor Inspeclion shell be mnde 24 nrs in advance-phonr.2SB•EB�O. <br /> 2.All wo�k 5hell be perlo�med in accOrde��:e with Ihis permi�and curren�Gty ol Everett Design anA Canslruction � I <br /> Stendards end Specilicetions. <br /> 3.Cell locetion Undeiground Sorvice 4i rt.belore you dig.TOIL FREE MVMBER�•800•424��SSSS. � i <br /> I <br /> O I <br /> . AhJ'� LL7 T 6f.t(�D;: CHd�NL'ES 11U57 Fi[ APF � <br /> f'UEIL.IC WORk:5 INSPEC:TUk. , <br /> . !:EEf" CITY �=�'REE �'^ r.i.r- n��l AT A!_I_. Ti //� i <br /> i;. INSTAi_'_ W'� � \/♦ ' <br /> 9. MFlP'E SUf,'F. O <br /> - , � <br /> a . <br /> � <br /> 1CKNOWLCL`G[M[NT U� CONDITIONS <br /> 1 i„� ,�n,Ir��,�q�u�c!nwnevapplir.anl herFby a9rees to hold and sxve herm� <br /> ' _ —_�_. _. _._ . __ _ <br /> i��ss tM, C�ty ol [veretl Irom any and all claims loi Aampges. r.osts. <br /> _ /� //f , ezpenses oi rauses ol achon Ihat ma) erise because ol installahon <br /> �'�(�,(/u ��f /,y qG3�9 and memtenunr.c nl Ihe improvPmenl or o�her nght�ol-way �sr here�o <br /> ��*� o-��»� applied lor nnA further ac�rees lo mmu�.e ;amr, upon nnhce Irom thr <br /> Arnrovrd Im Cnnslruc}on Date �ilY nn to replace P�� property dnm.:qei Iherebv <br /> fl 'AL � . TION � ,7 D� � �3 . - ' S '�� - <br /> Appr��etl es Conshucled �ynntur 2� A t Dnle <br /> rvrm:�\I PU6L�CWORKSDEPARTMENT WORK H RIZED BY TH ER�AIT MUST BE $TARTED WITHIN <br /> �I 3200CederStraet 1B0 S OF DATF PCRN � S ISSUED AND THEI7EAFTER IS TO <br /> J E�e�P�� WA 9Az�� BE D IGENTLY PURSUED TJ CGMPLETION 7HIS PERMIT �1AV 8[ <br /> Paone.759-R�ttO �ANCELI FD BV THE CITV UPO� ANV STOPI AGf OP WOFlK nN THIS <br /> PPpJECl pVCR 90 DAVS C�URALIr1tJ <br /> � <br />