Laserfiche WebLink
Date 9C0g 07 -.'� <br />� Application For <br />PUB�.IC WORKS <br />O <br />O <br />O <br />tn o o u' <br />Print or Type Only� � `; ": � `: <br />P C•1 � O � <br />� CJ M <br />ni <br />«� «� w «� <br />�piCARaOo � <br />Owner <br />PERMIT <br />7�{ i5 C3Ro.4� wRY � vE�e,6 Ti <br />s AM� kS""f4�b�'P" <br />Applicanf M:.ding Address <br />Describe Proposed Work <br />Prolect Address lif knownl <br />Cily <br />7�//LD 267A/�✓/Nb !.!/,9.trL <br />GL <br />/2 iN N <br />�F� COA�C � <br />sl,v,a 3 6 r ni <br />(/`' / <br />PUEuc Worke Permn t /� � 7�2 <br />BICp. DeO�� • _ . <br />vuoi�c Woree �ee <br />iotal Fee $ <br />Less Aoo� Fee Pa�a $ <br />eai,��e o�P s Z o�v <br />��n <br />Zip <br />a�z �vc <br />ZSS-700 Z <br />�ivA 98z o3 ass -si 85� � <br />Atlach four (4) copies ot plans lor proposed work - Draw to scale and nole the following as applicable: � <br />� Property Lines • Centerline ol sVeet <br />• Outline and dimensions of all existing and • Indicate Nor�h <br />proposed structures on the lot • Show any proposed yrading changes <br />• Existing and proposed utilities • Sl�ow measurements <br />Nnone <br />Phone <br />PERMIT CONDITIONS <br />1. AI� calls �or inspection shall be made 24 hrs. in advance - phone 259•8870. <br />2, All work shall be pedormed in accordance with this permit and current City of Everett Design and Construction <br />Standards and Specilications. <br />3. Call Location Underground gervice 48 hrs. before you dig. TOLL FREE NUMBER 1•800•424•5555. <br />Y. .%/�// ozci�rrir�..�.L/,o ize,o,00�=�.,l�/t/'ei� �/���L.z'.A'Xi .f��-c/.JG�u/.�/ <br />Q�1�N� � � /QL�1-lqt�/�s-n'CP/ �J �C..�IR/ / !-G'lQ.NSN'IS WLt�C:- " <br />�! U <br />,s �.�.� � � ��- � � -� ��- � <br />��%q/� - o�- uJaj/ .�a c�c��� y fLf c o�ivay c+'z a.n.c� <br />O1Tl,�ttu /lk'Q��� � DUN+riL .Gi r.� � /LpC.G�or�c c ��- ,�tJ �' <br />�/LC� C�� � /Z(%rnCrUa.` 09� cz�,�,�'�� of .�c./�D/ ,�r , � <br />`/ 2!'/R6 � � / <br />� <br />Approved as Constructed <br />evcretl PUBLICWORKSDEPARTMENT <br />� 3200CedarStreet <br />Everett. WA 98201 <br />Phone:2S9-B810 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />� <br />O <br />� <br />� <br />O <br />a <br />The untlersiyned owner/applicaM hereby agrees to hold a�id save harm- <br />less the Gty ol Everett Irom any and all claims lor damages, costs, <br />exaenses, or causes ot action that may arise because of installat�on <br />� G�` �Q and maintenance of ihe improvement or other right-obway use tereto <br />applied for and furiher agrees t0 remove same upon notice iron ihe <br />Date Ciry and to replace public p�operry damaged the�eby. <br />� �r— ' �� <br />gnature ot Ap cant Date <br />WORK AUTH IZE Y TNIS PERMI? MUST BF STAP.�iED WITHIN <br />180 DAYS O DATE PER1+11T IS ISSUED AND �fHEREAFTEF IS TO <br />BE DILIGENTLV PURSUED TO COMPLETION fHIS PERMIT MAV B[ <br />CANCLLLED BY THE CITY UPON ANY STOPP�IGE OF WORK ON iH15 <br />PROJECT OVER 90 DAYS DURATION. <br />