Laserfiche WebLink
i <br /> ; <br /> � <br /> Date�� Se„ f �� ��ctif�.+. y/� �4 �„�,„�wo,..P�lm����_, 9 -2Z3 <br /> � q / �`� 'pS 1��__. <br /> Applice�ion For ��+i Dao� • <br /> PUBLIC WORKS PERMIT °°°°°W°,�,�°° <br /> totei r�e 6— <br /> lre��nn� fnr Vam S_ S3— <br /> o,�w���.n�� S 3 �_ <br /> Print or Type Only <br /> YY1d,��—��1� 9����_d�'' �.r� � � ��� <br /> wner Mailmg Atldresf C�ty Zip Phone <br /> �m.rn��rv1` 4 �5��� I s� _S'� 1'yr� ��3 ga��o5�5 <br /> , AppGcent Meding Address C� LP Phone <br /> Describe Proposed Work �-C=���7'�.C�-_ ` � ��( J/S'—�`�,r r , I�f`� 19--�— <br /> ," , W <br /> Prolect Address lil known� _ zZ'�— Y�/, ��'/�D '�'0. � <br /> Altech IOW(4)copies ol plans for proposetl wmk� Draw lo scale antl note Ihe lollowing as appGceble�. � � <br /> � Properly Lines • Cenlerline of street � I <br /> � Outline end dimenaions o1 all ezisting and • Indlcete Nor�h <br /> proposed slructu�es on the let • Show any proposed greding chenpes <br /> • Existing end proposed utllitie� • Show measurements � <br /> DO NO7 WRITE BELOW THIS LINE O <br /> PEFMIT CONDITIONS <br /> , 1.All celle lor inspectlon shall be made 24 hrs.In edvance•phane 259•881 O. � <br /> . 2.All work shell ba peAormed In accordenca with this permit and current Clly ol Everett Design and Conatructlon <br /> Stenderde end Speciflcations. <br /> � 3.Cell Locetlon Underpround Service 48 I��s.belore you dig.TOLL FREE NUMBER 1•800-424•5555. � . <br /> � <br /> , `l�, �:cal.' Cvn� ,��,' �t d �C7w �7., L�l,.,;_[!t�:,,� �[2.,✓y O <br /> ��n.•t..r o-w G /G-B9_ � � <br /> ��� � <br /> �� ��.9;�. �6 -c«�o- �. �co.��� ,C'o! .s��..11��e � <br /> �ih�crc�e� a� /1.�/Q�.�.� �i�tf' .�� cu�G O <br /> ,� � .���. .j�, �- 3�G . a <br /> � <br /> �. ��,,.�.�,.,.���,�w�..�.r- a .�,.�.,� ��.�r� �«,6�� <br /> «� ��y ��..,�.� � ��, ��`� ��.�.�-�.rt�:,�i��� <br /> [c.�(G✓ ��'�'�� -'{"t""'�"-"`� y"�� � �ACKNOWLE G MENT OF CONDITIONS <br /> U <br /> The un0ersigned owne�/appGcant hereby agrees to hold end seve harm� <br /> � less ihe City o� Everelt irom any and all claims br damages. cosls. <br /> �7 expenses, or causes ol ection Ihal may erlse because ol 'nslallation <br /> ���-CJ ��/��i �q—�G��J and maintenance ol Ihe imProvement or o�her righl�ol-wey use herelo , <br /> npplied for end further agrees �o remo seme upon notice irom Ihe <br /> Approved Consiruction �a�e Gdy and lo replj�pubGc propert ged ihmeby. '�.. <br /> i� % � <br /> --� �3 �/ , � ,. <br /> ���� - , / � ��% fj �' � -z� 8y �I <br /> FIN INSPFCTION ' Dale - <br /> Approved es Conafrucled - naWre ol Apphcent Dete <br /> everetl PUBLICWORKSDEPARTMENT LWORK AUTHORIZED B� IS PERMIT MUST BE SIARTED WITHIN <br /> � 180 DAVS OF DATE P�fSM1T IS ISSUED AND THEREAFTER IS TO <br /> 3200Ceder Sireat BE DILIGENTLY PUR$UED TO COMPLETION. THIS PERMIT MAV 8[ <br /> Eve�ett,WA 98201 CANCELLED BV THE CITY UPON ANV STOPPAGE rJF WORK ON THIS r <br /> Phone:259�8810 PROJECT OV[R 90 DAVS DURATION. I <br /> � <br />