Laserfiche WebLink
�8f8 •\ ��� 1 � Po�hc Woi4 Permit• Q <br /> ` �r� I /..7 <br /> Application For eiav osoi�• � <br /> PUBLIC WORKS PERMIT PueTol�Fe�Fae , <br /> lee�Appl Fee PUE S <br /> B�lanca Du� S <br /> Prin: or Type Only <br /> �i�_1-IA� "T�mm �71�.'�'t�iC:an� �1 `�'�� � - <br /> '�Owner Mallinp Addreae Clly Zlp Phone <br /> 1�'�tt.�Y�t�� Cr i� qain 6����1 �,/ �4��y_,:3�3-77D0 <br /> Appllcant Melling Addreae CII� 21P Phone <br /> Deecrlbe Propoeed Work . ��`nC.,¢ r4 � • � G..�/�1�� — <br /> �y� W <br /> ��ro�ect Addreee(II known) =4�c,,.r�Ci����� - � <br /> Attach(our(4)coples of plans for proposed work• Draw fo scele and no�a the Iollowinp ea eDP�icable: � <br /> • Property Linea • Centerline of atreet � <br /> • Outline end dimenelona ol ull exleling end • Indlcete Narth <br /> proposed al�ucturee on the lot • Show eny p�opoaed predlnp chenpes <br /> • Exlatlnp end propoeed utllltleg • Show meeeuremante � <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 1. All calle lor Inepection shall be mede 24 hre. in advence•phone 259•987 5. � <br /> 2. All wo�k ehell be perlormed In eccordancq wllh thls pe�mlt end current City ol Everett Oeelgn end Conetructlon <br /> Standerde and Sp9cllicallone. <br /> 3. Call Locetlon Underground Servlce 48 hra belore you dig.TOLL FREE NUMBER 1•800•424•5586. � <br /> �O Pr/r9ciC Guok'�Es i''F.c�iniT ,f'Ec�u�.�Fo s� /''-87 O <br /> ��.l�1.G <br /> � <br /> � <br /> � <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undereigned owner/applicant hereby apieee la hold enC eeve herm- <br /> leee tha City ot Everett Irom any and ell cleime for demepea coste, <br /> ezpeneos, or ceuees of ectlon that may erlve beceuse ol Inatelleilon <br /> end meinlanence ol the Imprcvement or oln•;a �ight�obwey use hereto <br /> . . appllad lor end lurther eBreea to remove yeme u0on nollce Irom the <br /> Approved for Conetrucllon Dete Clty and to replace publlc proparty demeped thnre6y. <br /> FINAL IN9PECTION Dete <br /> Approved aa Conetrucled Sipneture of Appticent Dete <br /> p�� PUBLIC WORKS DEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> � 3200CederSiraet 180 DAVS OF DATE PERMIT IS I.,SUEO AND iHEREAFTER IB TO <br /> Everatl,WA 98201 BE �ILIGENTLY PURSUED TU COMPLETION. THIS PERMIT MAV BE <br /> Phone: 2F9�BB7 5 CANCELLED BY THE CITY UPON ANV STOPPAG[OF WORK ON THI3 <br /> F'ROJECT OVER 90 DAYS DURATION. <br />