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o�i� -�1y `� <br />Applicntion fnr <br />PUBLIC ViiORKS PERMIT <br />Print or Type Only <br />� � . j,tj�`I�.%�,. �>a�, c.l'<;i,-/. � �i. <br />pN,�g Mading AdJir�s�. <br />�%1l%A�� %: <br />Applir a�t <br />'i y%13 <br />Pd�, Al'..'�:P.u„ � � ..—. _ <br />Di��u noni • — ---- —._. <br />vum.ci:w�•i:es ?q, p v -.. _ <br />.,:�A� �„ s _ <br />�onA�; �e.rva S_ — <br />B�'m�. Uoa S yJ' GV <br />/%%/i�� !C %' % f T: i �'� � �f, ��. <br />Melling Addro��•s � <br />CiIY 7ip <br />c�ic -- -- .. .z�n <br />�16�3�- <br />�'�"', T/�/�l <br />Pho,ic <br />Phonu <br />Doscrior Proposed work T,A15TAct ,7-5� .U�il1! CON��4'F7C" �'��'� k�/° % . — <br />Prolect 4ddre�.slilknownl —�l_L /'— �s �_�_ .S, Gv. __ �UT //�� ��"_ f� �ir'�. <br />Atlach fo��r (4) coples ol plens lor pr000snd woik � Dmw In �r.:,io ,r d note ihr lollqwing as epplicuble <br />• Propeity Lines • Con!erlme ol street <br />• Outline and dimensions ol ell existing nnU • Indica'e North <br />proposed slrucWres on Ihe lot • Show eny propcsed q�odm9 chan9es <br />4 f xi511ng and piopo5ed utili�ies o Show measuremeNs <br />INE <br />PENM��` CONDI11UN5 <br />1. All ni,� br inspoclion shall be made 24 hrs in adve�i:e � p�-�one 259•8815 <br />.. �L ..ork 5h.'� bo perlormad in aCcord:fnct� with �his peimit nnd curtenl Ciry ol Gverrit Design and Con,lr�r,tion <br />^ Standards end ��cUlications. <br />�. Call LoCalinn Undeiq�ound Se�vice 49 his belrn�� vau du� TOLL FHEE NUM�ER 1-BOU•�i24•5555. <br />fINAL INSP[CTION \ \ x <br />Apuroved as Cons��ucted \) V <br />�.�,�.�i,�� PUBLIC WORY.S DEPA7TAIENT <br />� �700 Ceda� Stree <br />F��ore��. W.� 98201 <br />Phone'. 299�0015 <br />� <br />� <br />ACHNON'LCDG[MFNT Of CONDITIONS <br />1 ho undrrsipneU ovrner/applicant lieroby n9rees to hold and snve ha�n�� <br />--- -- ---�� �- - less Ihe City ol Everett Irom any and ell cleims tor damages, cosls. <br />/ e.penses, or causos ul ection �hal may erise because of InstallnGo�+ <br />3,� a�d mnintenance ol Ihe �mprovemonl or olhor riglFol�way use herelo <br />applicd lor und lurthe� agroes to romove samo vnon nolice Irom Iho <br />��F City.a to rr.placa p blic piopertV damaged theroby. <br />/ � <br />� p/� / <br />__—_ —_ ({�. l�i �i ��'� — <br />Dnt�• <br />Sip ature ol ApPli .ant Dele <br />RK AJTHOF12ED BY THIS PERMIT MUST BE STARTED WITH!N <br />'1B0 DAYS OF DATE PEHMIT IS ISSUED AND THEREAFiER IB 10 <br />OE DIIIGFN7LY PURSUGD TO COMPL[TION. THIS PERMIT MAY l[ <br />CANCCLLf.D L�V THE CI7Y UPON �NY 5(OPPAGE OF WORK ON TH 5 <br />PR[1JLG1 OVLR PU DA1'S DURATION. <br />T <br />O <br />---I <br />r <br />m <br />--� il <br />n-� y <br />�m <br />0 <br />co <br />m �o, <br />.� - <br />c m <br />—� z <br />x —� <br />m <br />.o z <br />a -� <br />rx <br />.-� .-. <br />--I � <br />< <br />T <br />O .� <br />�� <br />—1 f`� <br />x <br />m �— <br />v: <br />0 <br />Clm/� <br />3 � <br />m <br />z c� <br />-� r <br />. r� <br />a <br />z <br />S' <br />D <br />> <br />3 <br />