Laserfiche WebLink
�a�Qs��� PubncWorksPermil• �/ � /�� <br /> Application For BIOp Dept • �� ��� <br /> PUBLIC WORKS PERMIT Pu0licWo�M�Fee — <br /> TaNI iee S <br /> Le���oo�Fae P�Id S . <br /> Bd�nce Due S ���� <br /> Print or Type Only — <br /> m��2ysu���,E ; <br /> �p � L�� �,2u,� �n�;�r�rT ias�� �� LY�l� ��l-9�l Z j <br /> Owner Mailing Addreas City Zip Phone <br /> i <br /> �3�K �sr_ ,�1 :� �y l�Gs����9��� ,�-��7 � <br /> Applicant Mailing Addresa Gty Zip Phone � <br /> i <br /> Daetrlbe Proposed Woik Tr-�-� � LS� <br /> ,���.c� W <br /> Pro�ect Addresa pf known) — �91K� �� � I, <br /> Atlach tour(4)coples ol plana lor proposed work-Drew to acele and note Ihe lollowing as epplicable: � i <br /> • Property Llnee • Centerllne ol atreet � ( <br /> •Outline and dlmenalona ol all existing and • Indicate North <br /> proposed structures on the lol • Show eny proposed grading changea . <br /> • EAleting and propoeed utillties • Show measuremnnta � <br /> DO NOT WRITE B LOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 1. All calls lor Inapectlon ahall be medo 24 hra in edvanca•phone 259•887 S. � <br /> 2. All work shell be performed In accordence with Ihis permll and cunent City ol Everett Desipn and Conalructlon <br /> Stendarde and Spacllicaliona <br /> 3. Cail Locetion Underground Service 48 hrs.belore you dig.TOIL FREE NUMBEA 1•800�424•5555. � <br /> O <br /> � <br /> � <br /> O <br /> a <br /> � ACKNOWLED6EMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby eprees to hold and save herm- <br /> less Ihe City ol Everelt Irom any and all clalma lor dameBes, costa, <br /> expensas, or ceuses ol ection thet may arlee because ol inatalletlon <br /> .� 1` � � � and malntenance of the improvement or other right•ol�way use herelo <br /> •"—� ��"' G `� h � applied lor and lurther agreea to remove same upon notice Irom the <br /> Approved lor Cons on Date City and lo replace public properly damaged thereby. <br /> /�_/_�� • � ^ ��^O7 <br /> FINAL INS ECTION Dete <br /> ApDroved as Constructed alure of Applicant Dato <br /> WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> everett PU9LIC WORKS DEPAn�.`+ENT 1B0 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � 32U0 Cedar Straet BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Everett,WA 98201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone:259�8815 pqOJECT OVEF 90 DAYS DURATION. <br />