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pe,e],31-9i TO P�STING� <br />'� -Z4� -Z8'� <br />v�Applitatlon For <br />PUBLIC 1i1/ORKS��jj�� i" 1�_� Pu�Tot�FoeF,� . — <br />� Ln� �po� Fea Pe f i <br />o�?€�� `�,c i��'� ." ��r, o�o,��ia -.�._..-.,.�.,�e Z0- <br />Print or Type Only � c, <br />ro r.i vi �- oa .a o c� o r� r� ij r.i �/t ••• <br />17 rT �� 0) N«� r�i . Y) ,� i.) ii) �r t� r�� M O <br />p �w m �n �O M '. rp M <br />� T 1 �N �M M �� H e�l e <br />� �� CS <br />Puebc Worx� parm+0 • �� (S <br />Blr)p Dept �_ J � 2 45� <br />Nppllbsnl <br />lZ - 12 <br />r� f�ny S�� �t G J t� ��.. <br />���z�u"���;� <br />Meilinp <br />Ev! t� �-.-�t �r a <br />O ]J I' <br />� .. �.., i <br />ol f' Oj <br />N1 M <br />� Oipp' [p.�J � f.�l tli c� yf o�Ojw'i G t� <br />� 3[ ��� fa� ['1 E fA 7,.-; <br />Geecrlbe Prop�aed Work f`I E..`✓ S' h`� � S�n'l: �H (`2S � C{Q.r�e <br />Prolect Addresa (il known) <br />— 1 ► 3+�.h <br />sT <br />Atte�h four (4) copiee of plane lor proposad work • Draw to acale end note Ihe lollowing as epplicable: <br />• Property Llnes • Centerline nl street <br />• Outline end dlmanslons of ell exleting and • Indicele NoitA <br />proposed etruCturee on �he lo� • Show eny prOposed grnding ch�anges <br />� EMleting and propoaed utlliliea • Show maesurements <br />PEfiM1T CONDITION3 <br />1. All calle lor Inepaction ehell bs mede 24 hre. In advence • phone 259•8810. <br />2. All work ehell be peAormed In eccordence with thla permit and current Clty of Everett Deelgn end Conetructlon <br />Standerde end Specllicatlona. <br />3. Cell locetion Underground Jervlce 48 hre. belo�e you dip. TOLL FREE NUMBER 1•800�424•5555. <br />-3 <br />•� , 1 N STALL I Z� RE � NF0f7�f_1;1 GON C_P�E.TE GJL VE�.T � 1�1 DITGt{ <br />/LT I�2 �V6w�`� LO GPt'T'� ON• P I PE ,S�-IAL.�_ � �N STR�62� <br />soP.s � Nc�r ���� f�NrnN�. <br />5� ►���VE�ti,s.Y S+Wt-L $E �A�l� •TO EDC�E OF pP�v�MEN'T <br />I N �O �Y <br />t'��. M�K�. 9-i�-�� <br />Approve�.lerConatructlon Date <br />� �' � i c <br />FI AL SPE TION �'��1� � �e <br />�1pp�oceA ae Const�ucted � <br />�PUBLIC WORKS DEPARTMENT <br />3200 Cader St�eel <br />Everett, WA 98201 <br />Phone:269�B81p <br />W <br />� <br />� <br />� <br />� <br />O <br />AChNOWL[DGEMENT OF CONDITIONS <br />The undatsigned owner/applicnnt hereby egrepe to hold end seve hnrm� <br />laes Iha City ol Evernll irum eny and all claims lor dameges, coats, <br />expensea, or causes of ection thal mny erise �aceuse ol installation <br />anA melntanance ol Mia improvament or other righhobway uae hereto <br />applied lor end luriher agreeS to remove same vpun notir.a Irom fhe <br />Cily and to replaca public properly dameged Ihereby. <br />� �..� ��,��7, �� <br />Signa�ure 1 Applican� Dele <br />WORK AUTHORIZED BV THIS PERMIT MUST BE STARTED WITHIN <br />1B0 DAVS OF DATE PERMIT IS ISSUED AND THEREAFTEH IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION THIS PERMIT MAY BE <br />CANCELLEO BY THE CITV UPON ANV STOPPAGE OF WORH UN TNIS <br />PROJECT OVER 90 DAVS DURATION. <br />