Laserfiche WebLink
Date1 ' 1 v�i, ��v.�.�s r-�m�i• __�J—•J_Sr.__ <br /> - AnP�icaiion For eina oeo� • ____ ._ <br /> PUBLIC WORKS PERMIT �������w�,�s��� -- <br /> 101TI�eC S _.� _ <br /> 1P39 P(ID� FP.p Vlid S <br /> Print or Type Only ���,�=P o�,� s ��- <br /> �T i��s�ti �'t��,�U,� ��� z �yw/ t� �K-,_..,t'I ��;C, C � <br /> Owner Mading Atld�ess Gry Lp Phone <br /> �,'1. ii.,� �l�i,.e���.c ,SJhc�1 �Grl'��v �Z•ei�-G� lt'�c � .2e7 �:6"�5��/ 5� �s� <br /> � AppGcant Maihng Address Gty Lp Phone <br /> DeSC�ibe PrOpoSed Work �/v 5 ��+ � O/ �- ✓C/'�./(l /o/Z <br /> Prolect Address pt known) �1 � � <br /> � <br /> Attach fow(�)copies ol plans lor pwposed work- Draw to scale and note th�tellowing as app�iwt ie: � <br /> • Property Lines • Centedine of street � <br /> • Outline and dimen�ions ol all eaisting and • Intlicate Norih <br /> proposetl strucW rPs on ihe lot • Show any proposed c�rading changes <br /> • Exisling and proposed utilities • Show measuremenis � <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 1.All cells for inspection shall be made 24 hrs.in advance•phone 259•8810. � <br /> 2.All work shall be performeA in accordance with this permit and current Cify ol Everett Design and Construction <br /> Stendards and Specifications. <br /> 3.Call Location Underground Service 48 lirs.before you dig.TOLL FREE NUMBER 1•S00•424-5555. � <br /> O <br /> � <br /> � <br /> O <br /> a <br /> ACKNOWLEDG[MENT OF CONDITIONS <br /> The undersigned owneiiapplicant hmeby agrees to hold and save harm� <br /> less Ihe City ot Everett from any and all claims la damages, costs. <br /> expenses, o� causes of action that may arise because ol mstallation <br /> ����J��_ % �� � %� and maintenance of Ihe miprovement or other righPul-way use here�o <br /> applied for and further ac�rees to remove same upon notice irom the <br /> Approved for Const�uct� � Date City and to replace pubhc pioperry damaged Ihereby. <br /> /o � � �7 s <br /> FINAL INSF'ECTION � Dale ��v�^1�' /,� ��� < <�S Cl � <br /> Approved as Constructed ic�nature ol Applicant � Date <br /> WORK AUTfiORIZED BV TIiIS PERMIT MUST BE START[D WITHIN <br />