Laserfiche WebLink
, <br /> D8t8 � / � Pupec Wor��P�rmp• <br /> t� <br /> ApDlicahon For ama oao� • �� 1iL`51_ <br /> PUBLIC WORKS PERMIT P�����w�.k.�.. <br /> ,o�.�F.. � <br /> �o.eooi Fs�v�m � <br /> Print or Type Only <br /> B.i.�p Du• { <br /> � • W .��,)cie � � /�(o `�A.e 4�a/�4 Jl'414� �_� .�s.3 - 3�77 <br /> Ownar Mellinp AOdreas Crty Zip Phone <br /> �� <br /> Appllcent Malling Address Cily Zip Phone <br /> Deacribe Propoaed Wark _���GS'e— <br /> Pro�ect Addresa(if known) ��� '� /C 1J7�f h An7 � __ � <br /> � <br /> Atlach lour�41 coplea of plane fo�proposed work� Draw to vicele and nole the followmg as apphr.eble � <br /> • Property Llnee • Centerline ol street � <br /> • OuUlne and dimeneione ol ell e�isfinp and • Ind�cate North <br /> propoaeA etructures on the lot • Show eny proposed�rading changes <br /> • Exlelinp and propoaed utllitlea • Show mensu�ements � <br /> DG NOT WF17E BELOW THIS IINE � <br /> PEHMIT CONDITIONS <br /> 1. All calle for inepectlon shell�e mada 24 hra in advance� phone �59•88�5. � <br /> 2. All work ahell be peAormed in accoitlance wdh thig permlt and current City ol Evarelt Design and Consiruction <br /> Standerde end SpeciHcatlons. <br /> 3. Call Locetion Unde�Oround Service 48 hrs. beiore you dlg.TOLL FHEE NUMBER 1•800•424•5555. � <br /> wd.�k s <br /> 0��.� � <br /> �o P� 6��� i2�,a;.Q�� �' <br /> �i� <br /> G {�t�n+n,. O <br /> �� n <br /> �-y Yy a. <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersignetl owne�/applicaM hereby eprees to h,�ld and seva herm- <br /> —� lesn the City of Fverett trom any end ell cleims lor damepes. coats, <br /> ezpfmses, oi [eu9e5 of action that may eriae because o� inetallahon <br /> and maintananca ol Ihe improvement or other right•of-wuy ucr, hereto <br /> applied lor end lu�ther aSirnes to remove seme upon notice Irom Ihe <br /> Approved for Conetrucllon Data ' City and to replace public property demaged theraby <br /> FIMAL INSPECTIOIJ Dnte ^ <br /> Appioved ae Constructed Signatwe of Appucant Dete <br /> ���erett PUBLIC WORKS DEPARTMENT WORK AUTHOR12ED BV TI.fS PERMIT MUST BE STARTED WITHIN <br /> � 3200 Cadar Slreet 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFT[R IS TO <br /> Everett,WA 98201 BE DIUGENTLV PURSUFO TO COMPLETION. TH�S P[RMR MA�' B[ <br /> Phone: 25B-B815 CANCF.LLED BV THF CITV UPON ANY STOPPAGE OF WOFK ON THIS <br /> PROJECT OVEH 50 UAVS DURATIOII <br />