Laserfiche WebLink
�� � � <br /> d <br /> �Hrn <br /> yi (y� r�m�.,w�„�s vn�mn.p� /� <br /> MV _ • ' — <br /> FV � Dele � �/v mae o�o� • --I1��al�--- <br /> �y � APPlicetion Fur __ ___ <br /> � PUBLIC WORKS PERMIT °°".`,:�F.:`°° f <br /> Hy � - <br /> X �eu�oN F•ev�m S <br /> O Baie�ce oue S <br /> p H d Print or Type Only <br /> ��S <br /> ��� �1 , �/'n �f� r s b��C —�,�e�ny� �T�G � 355 �zy�� � <br /> �y /l I f� ��-1-{ M i�ling Ad�ess � Ci�Y Z P Phone <br /> Owner <br /> O y�"� {�•7 //'Po� �C1UT �j/ � l ' (9NnI fh/�(. .j—rN.N/T ���.�d / r_ _ c� <br /> n ty �p Zip Phone <br /> p Applicanl Melling Atldress ���Y <br /> [+4 � � <br /> y / � • (_ r�. _/n �!1 �y/����/�Dl�/1l / <br /> O� Describa Proposed Work _���-(�-��� <br /> '_ M-7 `7 � <br /> Project Atldressl�l known) _ �, (/"�' �� ���� /\„� <br /> � <br /> AtlBch low�4)cop�es o�Plens lor propOsed work�Oraw lo scale and nole the lollowing z s applir.able. � <br /> • Property Lines • Centerline ol slreel <br /> • Outline end dimensions ol all eeistin9 and • Indmale Noilh <br /> pr00osed 51rucNreS on Ihe lot • Show any pioGosetl qradm�chanyes <br /> • Exisling anA proposed utilitles • Show measure:nents M <br /> W <br /> / DO NOT WRITE BEIOW TI115 LINE O <br /> I C� PERMITCONDITIONS � <br /> i 1.All ca11910���spection Bhell be mede 24 hr6.in advence�phone 25J•BEIO �\ <br /> 1 2 All wo�k shall be peAormed in accordence wilh this Oermil and current City oi Evrrett Design anA Cunslruction � <br /> Slendarde end Specificetions, � <br /> ' ��� 3.Call Locetlon Underground Service 48 hrs.before you dig.TOLL FHEE NUMBER 1•800•4?4•5555. <br /> 1 � � O <br /> ; `'/W 1 c1zM � T N L�.1" �'�:'�.. <br /> I <br /> � L=�� � � F- <br /> I «w�- �ti1� K�._ � <br /> �� �' /� � �`.>c O <br /> � <br /> � 1� <br /> �� <br /> ACKNOWLEDGEMENT OF COND�TIONS <br /> C� The undmsiyneA owne�iapPhcant hercUy ayrees to hold and save ha�m- <br /> less Ihe Gry o� Everetl Irom any anA all claims loi damages, r.osis, <br /> e+.penses, or causes ol action Ihat may anse beceuse ol installation <br /> and mainlrnance ol ihe unprovement or o�her rlght�ol�wny use i�e�eto <br /> applird Irn ;md �wiher a9r��es to remove samr. upon notice ��oin the <br /> Approved lor COnsiruclmn Dale Cily ancl In�rpLn'.c Pubhr,proP�`�N�1ama{7ed ihereby <br /> FINAL INSPECTION ���� -- -"-- � Dnte <br /> APProveA a6 ConslruCled Siqnalura ol Appbcanl <br /> WORK AUTHORIZCD 13Y 71115 P[RMIT MUSi BE ST�RTE� W11HIN <br /> rverrlt PUBLICWORKSDEPARTMENT 180 DAVS OF DATE PERMI7 IS ISSUED AND THEREAFTER IS TO <br /> � 3200 Cedar Slreet p[ DILIGENTLY PURSU[D TO COMPLETION. THIS PERMIT MAV BE <br /> Evurett.W/+9P2ot C�NCCLLCD NY iH[ CI1V UPON AYV STOPPAGE OF WORK ON 7H15 <br /> Phone 259�8910 1'170.If G1 OVF f7�l0 DAYS DUf1ATION <br />