Laserfiche WebLink
� <br /> . .� <br /> \�__ /�_�� ' Puel�cWorR�Pami1• <br /> gY i� o <br /> �8te � BIJp U�D��• <br /> ppplleatlon For <br /> PUBLIC WORKS PERMIT °"°"`W°"`.`.. • a� '--��— <br /> ToblFe� <br /> Uu�DDI F��PUE { ��p Q <br /> 8�1��1C�DY� S�� � <br /> Print or Type Only �9��3 <br /> 7�u.11 �'F�SG�/�K fY:/o'd _ ��.is2�/7 �:i,�n§ � �' � - �4'/6 <br /> �IGIC T�H H Z�p Phon9 <br /> pwnar Melllnp Addrees ���Y <br /> ^ � .� 4 � �-�t�ri7 �/'e.��,�� 3s•3-77� <br /> �� ,,. T ��ELiIR�r• �L_,vl• �/C7 �� 6itC d!! r <br /> Appllcanl <br /> MaIIInUAddrese City Lp Phone <br /> !� �h.:,c�-�T i�,���i �A,�;ly �SS i — — <br /> Dsecribe Propoeed Work • <br /> - W <br /> -- ���- F' <br /> 3 ._ �s c0.� e �r�� F, <br /> Prolect Address(If knownl . _ <br /> All�ch lour(a)coples ot plt�!f0�V�opoeed work• Drew�0 6r.ele end no�e�CenlleWine of stpee� eble: � <br /> • Pruperly Linee • Indicele North <br /> • Outl�ne and dl�nanelone ol ell exlnting and � $how any oroposed greding chenBea <br /> piuposed etrucluree an tha lot � Show meeaurements M <br /> • EMletlnp and proposed u911tiee W <br /> DO NOT WFITE BELOW T41S LINE O <br /> FERMIT CONOITION9 � <br /> 1 All calle tor inepecllun 6he11 b• mv�e 24 hrs In edvence-phona 259•887 5. <br /> 2. All work ehell be peAormed in ucccrdanrn wlth thie permit end current Clty ot Everel�Design end Construclion <br /> Standarde end Specilicellona � <br /> 3. Cell Locetlon Underpround•iervice 49 hre befora you dig.TOLL FREE NUMBER 1•80Q•424•55 . <br /> O <br /> � <br /> � <br /> O <br /> a <br /> ACKNUWL[DGEMENT OF CONDITIONS <br /> The undnc:��yned ownar/epplican�hereby egreas to holJ end save herm� <br /> less the City ol Everatt Irom eny and ell claims for dameges, casts, <br /> /� expenses, or cauaes af ection that mny erise because oi installalion <br /> �� _/S�� /' _ y a� ,�,/ end melntenence ol the Improvement or other nght�ol-wey uce hereto <br /> ih✓ •�-�__� apUGed lor end lurthar agrees to remove same upon nollce Irom lhe <br /> A oved 1 �Consl tlon Dete - City and to replaca puql��roperly d�rnegad Iheraby. <br /> . u�� � <br /> Z , /�. � � <br /> , .� .��_ -�� �/�G, l �5�-�_��- �� <br /> ' r � �v _ <br /> FINAL IN ECTIO�� Oete �-�-f�`'" " � Date <br /> •\ SigndKre ot Applicenl <br /> Approved ae Cons�ru:ted 1 WORK AUTHORIZED BY THIS f EFMIT MUST BE STARTED 1VITHIN <br /> everett PUBLII;WORKS�PARTMENT 1B0 I�AYS Of' DATE PERMIT IS ISSUED AND ThEREAFTER IS TO <br /> � 3200 Coder Sireel BE DILiCiENTLV PURSUED TO COMPLETION. THIS PERMIT MAV BE <br /> Ev��re1�,WA!?9201 GANCELLED BY THE CITY UPON ANY:TOPPAGE OF JJORK ON TNIS <br /> Phone: 259�r�F15 , PA.'1JECT OVER 50 OAVS DUHATION. <br /> ` J <br />