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� � ; <br /> ay '"H � ' <br /> t" Hfn � <br /> H �� <br /> FC (] � /- /�., q' / y <br /> 'it H� Date�J..�L/ 71 a„�i��wo�ws aa�mn. �! `� � <br /> y y -�.,' � � AppliC2tion FOr TO POSTI NG �•� Bm� Dem ���p� Z� <br /> � �d PI�BLIC W(JF3KS PERMIT ��°r�,wF��F�� S _ <br /> O H� L��ss Appl Fee PaN S <br /> n 00 <br /> o�e� Print or Type Only e,,�,���eo�r s aG— i <br /> gzy� <br /> Ny Geonerrv 19�y - N ��'`� Ci'- _Snr��`i'�e �1�/03 Sy7-�d/-�' <br /> H Owner Maihng Address City Zip Phone <br /> C��V� <br /> RI t" �� � <br /> . <br /> L*1 <br /> y HO y �pplican� Mailin9 AdAress City Zip Phone <br /> Describe ProFosed Work n(�_(,(J .f�uie '�d vN i�L�N�re /.,�/a [i 7�'n/'�� [�_ <br /> v <br /> ProjectAddress�ifknow•ri) �ZG – 2��Fth Ur_ _�','F __ � <br /> - — � <br /> Attach four I4)copies of plans for proposed worM - praw to scale a•u7 nule ihe lollowinc�as applicable: � <br /> • Properry Lines • ;entedine i�•f street � <br /> • Outline and dimenslcns ol all existing and • Indicale North <br /> proposed Siructures on(he lot i Shov+any proposed gradic3 changes <br /> • Exisling and prOposed utilities • Show m�asurements � <br /> � '�' �i0 NOi'.^!RI�E BELOW TNI E <br /> PERN�IT CONDITIONS O <br /> '�I i.All calls tor inspe tion shall be rna;e 24 hrs.in advance-phone 259•$810. � <br /> 2.All work shall h,;pedormed in accor.lance�vith this per.nit and currNnt City oi Fverett Design and Construction <br /> '�� Standards and Specifications. <br /> '_' 3.Call Location Une�ergrour�d Service 4B hrs.6elore you dig.TOLI FREE NUMBEv�-$�-424•5555. —. <br /> /. JyL[.[.�Cc</Cf/�J- QCCC:>o�� '�/�0.��.: ��La ..c0 L�t' ,Grso,(ac-C�q� � , <br /> =1 f7?/L Ct.Ly/ -f-�o-+zl�xiuY' ���7 � i <br /> ' _'� !l�iuxc✓a f 4tGeo-y ,ca ,fo be.��-..�r�.�6� a, ete26�yccG`�-J <br /> � C�cr+zcu-.ti C�+n/�qnufF�sb� cnrn�oCefily cu�:-c�6cfar� o�r��.ny on�/,��;r7. � � <br /> ` �c'J. CL.�i/ d'�4'-Gh.� 4�]{ i4p /3L �f� �t-C't'�tn-✓ � r:.Gt �C.`tnvy`.� <br /> � s - <br /> y�.> ������ -�u� be Q<<:.��...� .�� �. z �s�,�-«�;� � <br /> t�i�l/' � /a�Q.�c.a' m� .�it��oG� <br /> t7. �rn.msF�nv� o��f/a.ne�4�i�a�,r.y .�.zl!" �X ,t���'..�.oF ✓ra. <br /> f?�6!�C,/. iifr�k�. �.(c -�/tTti �!/�.��'J �/Jiuc-�e �.Ct�n�ti/�.��- � �./ � i <br /> ' 8. .%�. /L[6T <UlfA3'^.i L�C*XJ2 .���4�f. ee� � Cl��a-G�u�LUt�J • <br /> � <br /> � � C:.Cr�b 9G�fi4.'/' 9n�S.c�..cJa�.� ��� fiS� `J�c7�' o••: h��✓ crn`/ G�n�/a�na}ec✓ <br /> � � � fY�erefc S;SzLC lie izy�lcced �i� 7`�i�' disC�*'_ /icn oFf/.^ <br /> `��,1� �'�r"4J`� ACKNOWLEDGEMENT OF CONDITIONS <br /> 's' ��� y! /�L���i C Cz�OY.f'S ^��Sf��'-Cfn�'- The undersigned oH�ner/apP�ican;hereby agrees to hold and save harm- <br /> less Ihe City of Evere�� Irom any anJ all claims 'or Aamac�es, cosis, <br /> �� � �J expenses. or causes of action ihat may arise because ..�r inatallation <br /> ---<-i�L— :J7 � �_o7.J 9� and mainfenance of lhe improvemen� or other riyh��ol-way i � �F��eto � <br /> � �Z" applied lor and further aorees to remove sarne upon noticn (-,m Uie <br /> ApProved r Ccnstruction Date <br /> , �� City aad tU.rep�ce public property dnmaged Ihereby. <br /> / <br /> i /i� , / � / <br /> � � / L^-'— —_'iL.C��/� / ��j ,\ 4 ../ �.,q,�� <br /> FIN L INSPECTION � !� � Date � �-��-� ' <br /> Approved as Constructed igna;ure ol pplicaot D�ate <br /> everett PUBLIC WORKS DEPAHI MEN' WORK AUTHGRIZED BY THIS PERMIT MUST BE STAFTED WITHIM � <br /> � 3200CedarStreet 180 DAYS OF DATE FERfAIT IS ISSUED AND THEREFFTER IS TO <br /> Everett,WA 9B201 BE DILIGENTLY PURSU[U TO COMPL[710N. THIS PERMiT MAY BE <br /> Phone:259-8810 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 D.4YS GURATION. <br />