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� ia � e. ���� <br />npplicalion Fm <br />Put�bo Wnrts I'r.inul � �� � � � ..J � <br />F��,�,� n���� . _J���2�/�'� Z—_ <br />PUBLIC WORKS PERMIT '����"��,aF;�`�� � <br />1r55PLpl inCVR�d + <br />Print or �ype Orly TO POSTING__!�� �`1 °'"''"" n1ie s zO--- — <br />�tv Z�u <br />s�,� e <br />��plicant Ma1GngAAd�ess Gty Zip <br />Dcscnbr. PropoSed Worh <br />Prole�i Addrr.ss (�1 knnwn� � � � —�1 S l'1^ 5-k— S\�/ <br />Attach four (4� copies ol pians lor proposed N•ork � D��w to scale and note Ihe lollowing as aLphcnUb� <br />—�ic� <br />• Pioperly Lines <br />• Outhne and Annensions ol all e.istmy and <br />{lfOp051?d SIrpC�IlIP.S 00 �hP, Ip� <br />• tri;tinq ��nA nroPosed ulili�ies <br />�� <br />• Cenledine ol slreel <br />• Indir.atc No�th <br />• Show nny PropoSPd 9ra:Lntj chnnt�e�. <br />• Show measuremenls <br />� <br />PERMIT CONOITIONS H0002h9E1� <br />1. All cails lur inspedion shall be made 24 �is. in advance � nhonr, 259•8810. FLDP 4459..50 <br />2. All work shall be pertnrmed in accordance v:ith ihls permil and cwrent Gty ol Everett Desi47t�tl ConsIr06Elph'.0 <br />Standards and Specilications, f 490.00 <br />3 Call Locnlion UnAr,rqround Scrvicc 40 hrs betoir, you di9 TOLL FREE NUMBER i•BOO��5rJ55. �i ap <br />Phonc <br />Phone <br />_��.�. �_M�� _ 4 -3o-�i <br />pp��mvi�rl lor Cu,•struCl�f Dile <br />' /�- / i <br />�!— /(.�1�C�l��"�__ . - //' i% <br />FINAL M ;P[CTION Dalc <br />qpprw��d ,i ; Constructod <br />+ PUBLIC WORKS OEPARTMENT <br />�� .i200CetlorSVeet <br />� Evnre�l.WA9P701 <br />ph-.�nr 2tin�l3litn � <br />OS'VW',' S�0.00 <br />ItOl�U28.^.7L. <br />g�WfF' 4;0.00 <br />ll71 -5 5650.00 <br />U�0007:�-? <br />W��T�i, ? 'r. . <br />I.�i�—i��l. Y� .,_ .'��I� <br />ACKNO�4LEDGEMENT Of COfJDITIONS <br />W <br />� <br />N <br />ne <br />• <br />� <br />O <br />Thr. undersigned owne�/epPhcanl hereby agrees to hold and save n:u,n <br />Icss the Gity ol [vere'I Irom any anA all clauns lor damaqes, r.�: ��. <br />eMp�n,es. or causes ol achon Ihal may nnse becazse ol instellal�,�� <br />antl mn�nlenince ol the improvemenl or other righl�abway us� hnir�b� <br />aUP���'d �or �nd lurihc� aq�ces lo remove same upo� nolice Irom nu� <br />Cily anA to replacr, pubhr, praperry dama9ed �hereby. <br />� . / <br />� '���: S' �� — j ' <br />��,. � � ;_ � <br />SicJnature ol pplir.a t ���' <br />WORK AU7HORIZED BY THIS FERMIT MUST BE STAqTED W!THiN <br />1H0 OAYS OF DATE P[FMIT IS ISSU[D AND THEREAFTER IS Tp <br />Ei[ DIUGGNTI.V PURSUED 10 COMPLETION THIS PEPMIT MAV F3� <br />CANGCI I.f I� RV Tllf CIIV UPON MJV STOPPAGF OP W(�HN (l:J THIS <br />1'H�1.11 � I ����f R'�P D4Y�S DUHAiII"IN <br />