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��, <br /> � � '� , <br /> .o � x <br /> C H <br /> � Hrn <br /> y� r�-+ <br /> �C C� <br /> � rxi � Dale�,.��u�� , .. ` . �„�,:,�wo,�sP.,m +�y/ <br /> � � H 5ina Deo�_. _ � 9��(�-� <br /> Applicaticn Fo� <br /> �iy� PUB�.IC WORKS PERM9T `.,����"-°°,."��------_ <br /> r,.�.,�F�� S----- <br /> z � �, >��,: ����,:,,� s ------ <br /> He� � ��.,� ..�.,, s — <br /> �„ a ,.. - --- <br /> H Print or Type Only - -- <br /> t" �� <br /> g�H C.������t I �--t���?:-�'� ,- 1�-- -- - - <br /> OC.17U1 Ownei � Motlmy , '�qn.�_ l'.n1 ZiP Phonc <br /> C+]� L*1 _ - ' <br /> x y � Afadmu Addiess Cih• Zip Phone <br /> y p (p Applicant <br /> Desr.ribe Proposed Work _ � � '��^' �� - -- , <br /> I - - 1 _ � , <br /> Projecl Address 1�1 knowN � � � �--�-�-�{-- 7 ^ "'—"'--- H � <br /> `J <br /> A�taeh lour I�I ��OpICS o� plan5 lor p�OPOSed tVOrk- DraW IO Swle Antl nOIC IhL+�OIIOWing as anP��cab�c: � I <br /> • Property Liner. • Crnledine ol street � <br /> • Outhne and dimensions ol alt c.�stmq antl • Indicale Norih <br /> . proposed struC�ures on Ihe I�t • Sho�v any proposed gratling c'�anc�r.s <br /> i ` • ExisUng ;md propuSCA Wilihes • Show measuremenis /� I <br /> I W . <br /> �� DO NOT WRITC- BELON'THIS UNE O I <br /> i <br /> � ' PERMITCONDITIONS �. <br /> � �_ 1.All calU for in,pection shall be made 24 hrs.in advance-phone 259•SS7O. � <br /> � I 2.All work shall be pedormed in accordance with this permit and current City ol Everett Desic�n and Censtructicn <br /> �� Standards and Specilications. <br /> � 3.Call Location Underground Service 48 hrs.l�etore you dic�.TOLL FREE NUM6ER 1-800•424•5555. � <br /> j �'-� ''�� ���'T '��' � G <br /> < <br /> �L�/i�cM�z ' <br /> J'-/O-�i � <br /> �i� � <br /> Q <br /> � !li �- <br /> � ' <br /> � �- <br /> - <br /> I oI I. ,1CRNOVJLf.DGEt.tENT O� CONDITIONS <br /> l <br /> \ Thi�underc;iqnr�d mvneVapphcant hi�ieUy;�9recs to hold and savc h:unr <br /> — — Icss iho Ci�y ��� F=veretl liem any �nd all clalms lor tlamoc�ca r.osts <br /> e*Pen';rs. or causes of action Ihat may arise because oi installition <br /> and mamtenance nl the imp�ovemenl or other nghPobway us�� nerc�o , <br /> . appheA for and iwiher agrnes to remove same upon nolice nom thc <br /> ApproveA for ConsVuction ���e City and to rePlace puUhc property dama{7ed Oiereby <br /> FINAL WSP[CTION ���P — �— <br /> Approvud a5 Consirucied Signalure ol Applicant ��'�" <br /> WORN AUTHORIZED BY THIS PERMIT MUST DE ST�RTED W�11IIN <br /> �•vrmtt PUBLICWORKSDEPARTMENT 1B0 DAYS OF DATE PERMIT IS ISSUEG ,1ND THEREAFTER IS TO <br /> � 3200Cetl::-Strccl I BE DILIG[NiLY PURSUED TO COMPL[TION. THIS PFRAIIT AtA': BE: <br /> Everell,WA 99201 CANCELLED BY THE CITY UPON ANY ti70PPi�GE OF IVORK ON Tf�uti <br /> �hone:259�na10 PROJ[CT OVER 90 DAVS DURnTIOnI. <br />