Laserfiche WebLink
�� <br /> Date��� � /Z��_S <br /> Pub4c Nlorks Pcrm11 v <br /> ApplicatiUn For ema�oer�+ 7 7? <br /> �.i w■ <br /> R]��e �� `�,Ob�� r'cy;IA �� PUEIicWorksFee — <br /> �- � vv n r �: n ve Totel Fao S <br /> Less Appl Fee PaiE 'J <br /> ' � c:� rt'� C� �- Balance Due S '�'S�o <br /> Print or Type Only " ''� <br /> � , , � � � Oo2-32z- �yc-O�JO-/7-fi>^0 <br /> ��:; ��.; f <br /> f'�ru� L-�� � - "15�� �' �v GcJ/�1 ai ��� ��_,� ,,�.��_ <br /> Owner MailingAda�ess;�, ',.-; ,r; �,- City Zip Phone <br /> o c� <br /> r� � ti) r <br /> �//Sf /,�-� � ���.� ' , <br /> �:� <br /> � , ; r <br /> Applicant Ma�4ng Address City Zip Phone <br /> Describe Proposed Work _ ��� <br /> -- � <br /> Proi�ct Atldresc(if known) J �� �L/ � � <br /> Attach four(4) copies ol plans lor proposed work- Draw to scale and note the lollowing as applicable: � <br /> • Properly Lines • Centerline of street ♦� <br /> • Outline and dimensions of all existing anu • Indicate North V� <br /> proposed structures on the lot • Show any proposed grading changes <br /> • Existing and proposed utilitie� S Show measurements �q <br /> �i �0�! <br /> �- DO NOT WFITE BELOW THIS LINE � <br /> PERMIT CONDITIONS <br /> 1.NII calls for inspection shall be made 7.4 hrs.in advance-phone 259^8810. � <br /> 2.All work shall be performed in accordance with this permit and current City of Everett Design and Construclion <br /> Standards and Specdications. <br /> 3.Call Location Undergrnund Service 48 hrs.before you dig.TOLL FREE NUMBER 1•800-424•5555. � <br /> � � � <br /> � !��1LC.- �.,�,,, ?�, �.�_.j` lJ< -C�__ , ���_.1�.-'-.-.� �i(�- .� G��G/ . <br /> b � <br /> � <br /> � <br /> � <br /> � <br /> ACIWOWLED3EPi[NT OF CONDITIONS <br /> The undersigned o�vner/applicant hereby agrees Io hold a�C save harm� <br /> — less the City of Everett from any and all claims for damoc�es, costs, <br /> - ���-� . ;- expenses, or causes of action that may arise because of installation <br /> /_�_� j y� and maintenance of the improvement or other right-of-way use nereto ��:� <br /> C— � -' applied for and further a9rees to remove same upon notice irom the l�� <br /> A pr ved for Go�pctip �te City an{i to replace public property damagad thereby. N�+ <br /> � .�/<%C/"��� — J ,i�f- �z �� ,;�/ / � / i1� �� a <br /> , , „l/ -� !->� <br /> FINAL INSPECTION Date ���' � ��' r�� � ��°i <br /> Approved as Constructed Signature of Applicant �� " Date k,,; <br /> PUBLICWGRKS�EPARThiENT WORK AUTHORIZED BY HIS PEFMIT MUST BE STARTED WITHIN ;'�i <br /> 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTEfi IS "J �''� <br /> 3200 Cedar Street BE DILIGENTLY PURSUED TO COMPLETIUN. THIS PERMI7 M!' �E �-' <br /> Everelt WA 98207 CANCELLED BY THE GTY UPON ANY STOPPAGE OF WORK C��' ,HIS `� <br /> Phone:259�8810 I PROJECT OVER 90 DAYS DURATION. � <br /> � <br /> I <br />, �� <br /> li��i' <br />