Laserfiche WebLink
�e�Q �/'� / ( ( Puetic WarF�Permn• �I <br /> Applicelion For BrnO DeDI •��� G y�� ��, <br /> PUBLIC WORKS PERMIT P��bcWorbie� <br /> ,o�.�... s <br /> leu ADDI i�a Pua � .. <br /> Bu�nc�Dua S <br /> Print or Type Only — <br /> �� �r.tG 3�o .� L�_.e.� �" /�u.�zs 9F z.i sr9-�P y� <br /> O nnr Meiling Atltlress City 21p Phone <br /> [Q--Ge��c%� <br /> Applicant Malling Addresa City Zip Phona <br /> Describe Proposed Work l � �f— �� ��U�Ca'���1-i--�-x+�.[..G� <br /> 3/e � — — _ W <br /> Pro�ect Addross(il known) �¢� � ��✓ Cr � <br /> Attach lour(A)copies ol ptens br proposad worh• �rew to scele end nole Ihe lollowing as appliceble: � <br /> • Property Linea • Canterline ol slreet � <br /> • Outline antl dimensions ol ell e�lsting and • Indicete North <br /> proposed slructures on the lol • Show eny proposed grading changes <br /> • Existing end proposed utilitiea • Show measuremenla � <br /> DO NOT WRITE BELOW THIS LINE <br /> PERMIT CONDITIONS O <br /> 1.All cells for inepectlon ehell ba mede 24 hra.In advence-phone 289•8B1 O. � <br /> 2.All work ahell ba partormed In acco�dence with thie permit end current Clty ol Everett Oesipn aod f,onatruction <br /> Stenderds and Spacilicetlons. <br /> 3.Cel'Lxatlon Underpround Service 4B hrs.belore you dlg.TOLL FREE NUMBER 1•800-424-5555. � <br /> ' (/p.�GC, LJO't/n �LMnc�` /v�+ �t�I, O <br /> 0 <br /> C�/,(/!/� �O�/�' � <br /> 2 -ir 9/ � <br /> � <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned ewner/applicaM hereby epreea to hold and seve harm� <br /> — less Ihe City ol Everetl irom eny end ell cleima lor damages, costa. <br />� axpenses, o� causes ol aclion Ihat may eriae beceuse ol Inslallation <br /> and mainlenence ol Ihe improvement or other �iphl•Ol�wey use hereto <br /> Approved lor Construction Date appl�ed lor end furthar agreea lo remove eame upun notice Irom the <br /> City end lo replace publlc propnrty demeBed thereby. <br /> FINAL INSPECTION Dale <br /> Apprpved es Constructed SiBnalwe ol Applicant Oata <br /> everett PUBLIC WORKSOEPARTMENT WORK AUTHORI2ED BY THIS PERMIT MUST BE STARTED WITHIN <br /> � 3200CederStreel 180 DAYS UF DATE PEPMIT IS ISSUED AND THERFAFTEFt IS TO <br /> Everet6 WA 98201 BE DILIGENTLY PURSUEO TO COMPLETION. THIS PERMIT MAV BE <br /> Phonn:259-fi810 CANCELLED BY THE CITY UPON ANV STOPPAGE OF WORK ON THIS <br /> PROJECT OVER BO DAVS DURATION. <br />