Laserfiche WebLink
�,�� <br /> i ��k <br /> K � <br /> ' - Cff`ya,. ,�_.� _. <br /> �.��.r: <br /> PunbcWo�ASPerm �� �� V/ <br /> Date� _ <br /> Application Fa e�av oer�., C— . � <br /> PUBLIC WORKS PERMIT P�^������,��F�a — <br /> ,o���Fe� $— —. <br /> LessAppl Fni Va�� S _ ' <br /> Print or Type Only `�'�"„°r°oc $ z�C// _= <br /> ��n�t�- `�(orrp_5 a�llan ��� 1�rPr� �'D��b -�18�-I ��9 <br /> Owner Maiting Atldress C�ty Lp Phone <br /> Apphcant Mailing Address City Lp Phone <br /> Describe Proposed Woik �� � J� � <br /> Pro�ect Address lif known) ���J—:� Cn���`-� � <br /> � <br /> Attach fow(4)copies ot plans for propo5ed work� Draw to scale and note the I�Ilowing as aUPlicaule; � <br /> • Properry Lines • Centerlinc ol street � <br /> • Outline and dimensions ot all existiny and • Indicate North <br /> proposetl structures on Ihe lol • Show any propo5ed giading changes <br /> • Ezisting and proposed utilities • Show meacurements � <br /> DO NOT WRITE BELOW THIS LINF <br /> PERMIT CONDITIONS O <br /> 1.All calls for inspection shall be made 24 hrs.in advance•phone 259�b 810. � <br /> 2.All work shall be pertormed in accordance with this permit and currecl City of Evereft Gesign and Construction <br /> Standards and Specifications. <br /> 3.Call Location Underground Service 48 hrs.betore you dig.TOLL FREE NUN,BER 1•BUO•424•5555. � <br /> 0 <br /> � <br /> � <br /> 0 <br /> a <br /> 4CKNOWL'cDGEMENT OF CONDITIONS <br /> The undersigncd owner/applicant hereby ayr±es to hold and save hann- <br /> less 1he Ciry of Fverel� from any and all c.;::ms br damages. cosis. <br /> expenses, or ceuses of action that may anse because ol insla�lalion <br /> � and m intenanr.e ol Ihe improvemenl or o�her right-of�way use L•ereto <br /> `j, :f"/'�.;._/Y .j—8 —� <br /> app�e for and further agrees lo remove same upon notice `�m lhe <br /> Approved for Construction Date Ci � an f to replace pu:lic property damaged thereby. <br /> �i�_ /G— {`—� � ( �--_��-- ' _ <br /> r'� "..�- ._, _.:'. - ...._ __���..�_ � I14. I o 1 <br /> FINAL INSPECTI•�N Date ! • � <br /> Approved as Constructed !S:gn�Inrm,h�A� pplicaN ,�_���� <br /> evcrett PUBLIC WORKSDEPANTM[NT WC AU�I\,�ORIZGD BY THIS PEFMIT MUST BE STARTED WITHIN <br /> 3200CedarStree� 160 YS QF DATE PERAIIT IS ISSUED AND THEREAFT[F IS 70 <br /> � Everett,Wh 99201 I BE DIL GENTLY PURSUED TO COMPLETION. THIS PERMIT A1AY BE <br /> Phonc:259�8810 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAYS DURATION. <br />