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--�, <br /> ��a � <br /> .O �lx <br /> C, H <br /> 9 H fn <br /> t� <br /> � �c-�� l <br /> H H Date���"��� r���,_�vo,..���� I' <br /> �G O mny oo�,i . <br /> y ',il ApDliw�ion �or � � <br /> � " � PUBLIC WORKS PERMIT ;':"'" "'°`"'�°° — <br /> m H r�,��F�� s <br /> H <br /> � �.•ssaon� veevmn 5 <br /> e.,i.,�r�o�� 5 <br /> O y � Print or Type Unly <br /> HI� � g <br /> y�Y � <br /> z H� s=�-a'l Yi'�i � ` 7� =i'��i�L _ <br /> .�.� y Madm9 AAdress' ��ly Z.ip Phonc <br /> Owner <br /> HH <br /> � y <br /> H <br /> C] � fp <br /> AppGcant Mailing AAtlress CeY ZiP Phone <br /> � �� Descnbe ProPosed Work �� `�l I,�� ���`�� �- "�—� --- <br /> — ` <br /> -- � ��l`� "� '`�' ' �' � <br /> Prolect Address 1��k � , — <br /> A�tach lour 1�)copies ol plans for proposed wo�k- Draw lo scale antl note the lollowing as aUPhcable: � <br /> • Property Lines • Centerl�ne of streel /^ <br /> • Outline antl dimensions ot all ezisling and • Indicate Norih V� <br /> ptopose.l siructures on ihe lot • Show any p�oposed�rading changes <br /> • Existing o�tl pwposed utihties • SI'�ow meas iremen!s /y� � <br /> W <br /> / .. <br /> DO NO7 WRITE BELOW THIS LINE O <br /> � C� PERMITCONOITIONS <br /> 1.All calls br inspection shall be made 24 hrs.m advance-phone 259•8810. � <br /> 1 � 2 All work shall be pedormed in accordan�e wilh Ihis permit and current Cdy of[verett Desi9n and Construction <br /> Slandards and Specilications. <br /> '�� 3.Call Location Underc�round Service 4B hrs.before you dig.TOLL FREE NUMBER 1•800•424•5555. � � <br /> ��� <br /> I 1 :�T �t-''c� � � <br /> � ���� �/f;�.Z/:, � <br /> � — '.�'_ . , <br /> / -i�� -� �' � <br /> �—�= � <br /> �_,_, <br /> a <br /> � ACKNOWLE�GEMENT OF CONDITIONS <br /> I� =1�1 _ 1he unde�siyneA owner/aPPlitant hereUY e9rees to holtl and sa��e hmm� <br /> _ less ihe Ciiy ol Everett from any and all claims lor daina9es, costs. <br /> eapenses. or causes ol aclion Ihal may arise because ol installation <br /> � nnA maintenance ol the improvement or other right-obway use hereto <br /> appGE>d lor and lurthcr a9rees to remove same upon notice Irom Iho <br /> Approved for Construction Date C�Iy and Ie replace public properry dama9ed Iherehy. <br /> FINAL INSPECTION Date <br /> qpproved as Constructed Siqnalure ol Applic�n� Date <br /> WORK AUTHORIZ[D BY THIS PERMIT MUST �E STARiED WITHIN <br /> rvrrctt PUBLIC WORKS DEPARTMENT 180 DAYS OF DATE PERMIT IS ISSUEO AND THEREAFTER IS TO <br /> � 3200CedarSlreel BE DILIGENTLV PURSUED TO COMPLEiION. THIS PERM1IIT IdAY �[ <br /> Gvcreu,lNA 9�201 CANCELLED �1'TIiE CIiV UPON �NY STOPPAGE OF 1NORK ON THIS <br /> Phonc 259-li810 PRUJCCI OVCR `.�� f141'S DUIb1lIOP1 <br />