Laserfiche WebLink
9 <br />` <br />� <br />I <br />Date��- TO POSTING � �ZI s� _ <br />Applicatinn For <br />PUBLIC WORK.S P�RMIT <br />P ' t T Onl <br />�Puoi¢ Wor�� �ermil • • L� �O / <br />��ap DaCt • — <br />v„ei�c wmx. r.e <br />, Tolal Fm s - <br />Les��pDl feePuO $- <br />uience Due � i �. <br />nn or ype v - <br />BD�Z -3Z2�/(Y 793/ <br />Rrc,F 1�'c•!-CY�r~r�a 111e_' c QOaB �c�ierkl.� Lah� Gvere�' .�$�3 �� 355-y77'7 <br />ner Mailing Address City 2ip�� �� ��•,. phona <br />�?04�1�'a�.Mar�'��/he�','« stn�w t3e'�jlu Lnne I?�ere�l- �i8zo3 � 355y'7�7 <br />pplicant Mailing Address City Zip Phone <br />Describn Propused Wo�k <br />Projeci Address lif known� <br />Attach four (4) copies ot plans lor proposed work � Draw to scaie antl nole ihe lollowing as applicaCle: <br />• Property Lines • Centerline ol sireet <br />• Oudine end dimenslons ol all e.isting antl • Indicate NoAh <br />proposed slructures on ihe lol • Show any preposed grading changes '� <br />• EzisUng and proposed utilities • Show measuremenis ' <br />PERMIT CONDITIONS <br />1. All calls lor Inspection shell be mado 24 hrs. in advance - phone 259•881 Q� <br />2. All work shall be performed in accordance with �his permit antl curren! City oi Everett Design and Construction <br />Standards end ipecifications. <br />3. Call Locatlon l�ndergrountl Service 48 hr . belorn you di�. TOLL FREC NUMBER 1-80�•424•5555. <br />, 7 I+Z�P,,c-zi a,�..:%/n2 ('����ccrc �,/Z�/ 6c i:i sfu,.cclC''v `i'+� <br />� Ck�s.vt�..t, /�PScc!?:��. ��'..i �7/i.✓ ..Px!'a-I.'r.�c"t» '�2tk� /�C <br />� <br />�j(t Hnt l.z {�'v+-c��?�o,,., . c'm.n.�.Cnd r,. .Ci%•a•E� Gc <br />�/ (j "�Jr-.v .fOZ .N)C'�i+�� /� -C.2a-r.-t'N .�f� J-clf�c� <br />0 �� <br />�.( �tCly rU'1, �LCnt.1��-i�c� . � <br />�l _ n n J/. .. _ fC .. � ! ^ / <br />J� .��ffT"c`-wxav .,.�,-,-�._ - n.,..l%�.c�l7i rr�� �.r�S�%a <br />�gs-✓. �17�-„-` c c� .G�141c. <br />SPC c�cn.- - C; 7S' G..� �.� <br />,, ., � n, n t S�ul.G /��is :t.� �� .�.. �� = : �j:;..:,r(, :<���Gn S� <br />C�v�,_P`aYt � <br />� <br />� <br />�w <br />_/ <br />O <br />a <br />�x .Lc�Cv S. /c `r. �- %J�' � ACKNOWLEDGEMENT OF CONDITIONS <br />n/ �� G p�' ihe undersigned owneqapplicaN hereby agrees to hold and save harm� <br />— less thu Gty ol Everetl Irom any and all daims lor tlamages, cosls, <br />expenses. or cawes ol acGon that may arise because of installation <br />� c^ and mainter.ance ol Ihe improvement or other righPol�way use herelo <br />_ pplied for and lurther a9rees to remove same upon notice irom Ine <br />���e City and �o replaCe pubhC properly dama9ed �helCby. <br />FINAL INSPEGTION <br />Approved es Constructed <br />�PUBLIC WORKS DEPAPTMENi <br />3200 Cedar Slreet <br />Everetl, WA 9820! <br />Phone: 259�BB10 <br />t 7z l ��`���J� <br />Dale <br />Si9nature af Ppplicant Date <br />WORK AUTHORIZEO BY THIS PERMII MUST BE STARTED WI7HIN <br />1B0 DAVS Of DATE PEFMITISISSUED AND THEREAFTERIS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAV BE <br />CANCELLED BY THE CITV UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS OUFATION. <br />