Laserfiche WebLink
I <br /> PaClle Wad�Pnmil� �S—27� <br /> Dete�� B5 f5�// <br /> eiac.o.oi.•�.��-- <br /> AppllCetlOn FOr <br /> PUBLIG WORKS PERMIT PuOTOWFesF•• • <br /> laU ADO�Faa V�i� s <br /> B�I�ncaDu� { ��'G� — <br /> Print or Type Only 7C�'S//� <br /> �la a Ar�e�s�� ,dr�d ��� t�- �8 ao / as�- �a� � <br /> Mellinp Address City Zip Phone <br /> Ow er = <br /> 0 <br /> -� <br /> � 'l' Pnone m <br /> ApPllunt Mailing Addreas ���Y Z�P <br /> ...r <br /> �i �1 <br /> Oescrlbe Pioposr.d Work �� — <br /> H� <br /> W g� <br /> � <br /> Proiict Addrese(If known) � �� <br /> Atl�ch four(I)caples of plene for praposed work•Drew lo acale end note lhe lollowlnp ea epplicable: � _ <br /> • PropertY Llnes � Centerllne ol atreet <br /> • Outline and dlmensions ol ell exleting end • Indlcate North <br /> propose�structurea an the lot • Show enY propos�d greding changes �N <br /> • Exletin�a,�d proposed utllitles • Show measuremenle M <br /> N T ITE EL W T I LINE O �� <br /> ��II <br /> PERMIT CJNDITIONS � m N <br /> 1. All celle for Inepectlon ehell be mede 24 hra in edvance•phone 259•8815. . <br /> 2. All work shell be peAormed In accordence with Ihie permit nnd current Clty ol Everelt Deslqn end Conetruction m <br /> Standerds end 8pecllicatlona. <br /> 3. C$II Loeetlon Underpround Servlce 48 hrs.belore you dig.TOLL FREE NUMBER 1•800�424•6665. � �n <br /> �r <br /> O • � <br /> � � <br /> � � <br /> O � <br /> -� <br /> a � <br /> ACKNOWLED6EMENi OF CONDITIONS <br /> .1r�� The undersigned owner/applicanl hereby apreee to hold end save harm• <br /> Or less lhe City ol Everett irom any end all clalms for demapea, coet4 <br /> expenaos, or ceuees o1 action Ihet mey ariae becauee ol Inetalletion <br /> r) Q/ and malntenance ot the improvement or other right•ol-wey uee hereto <br /> �� applled lo� end lurther aprees lo remove sama upon notice Irom the <br /> Approved for Conal uctlon a1e City end lo replaca public property dameged thnreby. <br /> - �1��r�6 <br /> FINA II PECTION Data Oate <br /> Approved ae Constructed Signal re o ApPlicant <br /> WORK AUTHORIZED BY THIS PEHMIT M ST BE STAHTED WITHIN <br /> everett PUBLIC WORK5 DEPARTMENT 180 DAYS OF DATE PERMI-i IS ISSUED AND THtREAFTER IS TO <br /> � 3200 Ceder Street BE DILIGENiLY PURSUED TO COMPLETION.THIS PERMIT MAV BE <br /> Everett.WA 98201 CANCELLED BY THE CITY UPON ANY STOPPAOE OF WOHK ON THIS <br /> Phone: 258-BB15 PROJECT OVER 90 DAYS DURATION. <br /> � <br />