Laserfiche WebLink
� � � <br /> � p <br /> pe�@�/Qv ' ' PuUM1c Worx�Permit• 7D _ � <br /> � � <br /> Applicallon F�r Binp Depl . _ <br /> PUBLIC WOR� PERMIT P�eTote iee�ee ` y�,y = <br /> len�apl fee PerU �� <br /> Print or Type Onry � r°R m `� C Bebnce Doe a ¢l 2 <br /> .+ �ippp� � <br /> '" .�n u� Yl .t <br /> () N N <br /> C �) V j���w �Mlf�P I y — y`� � 7.S— <br /> pW� Mallmg" rsa � � Cily Zlp Phone <br /> � ~ � � F3 <br /> � Applicent Mniling Adtlress Cily Zip Phone <br /> Dascribe Proposed Work �V P fi��( <br /> � Prolect Addresa 111 knownl r{!J-� / C�9f�-I-p-�-/— � <br /> � <br /> Aflech lour(4)coples of plene lor proposed wark• Draw to scale end note Ihe lollowing as applicable�. � <br /> � • Proper�y Linea • Cenlerline of slreel � j <br /> • Outline end dimenaions of ell e■isting and • Indicate Norlh <br /> propoead structure5 on Ihe lot • Show eny proposed greding changes <br /> � • Exlstinp and proposed ulilillea • Show mcasurements � <br /> � DO NOT WRITE BELOW THIS LINE �I <br /> ' PERMIT CONDITION3 O <br /> 7.All colle lor Inapection ehall be made 24 hrs.In advance•phone 259•8810. � <br /> 2.A�I work ehall be perlormed In acco�der�ce with thia permit and currant City ol l'veret�Design and Conatruction <br /> � Stendarde end^upecificalions. <br /> �' 3.Call Locetion Underpround Service 48 hrs.belore you dig.TOLL FRFE NUMBER 1•800•424•5555. � <br /> /ti, ,�✓ �v�..��v� ��� 7�/-9 o O <br /> H ! <br /> � <br /> � <br /> � I <br /> ACKNOWLEOGEMENT OF CONDITIONS � <br /> The undersigned nwne�/applicent hereby agreas to hold and save harm� � <br /> less ihe City of Eveietl Irom eny end ell cleime lor damages. costs. <br /> eMpenses, or ceuses ol eclion that may erlsa beceuse ol instellption �, <br /> �- and melntenance of the improvement or o�her rigM�ol�wey use herelo �, <br /> _ applie lor and urt r aBrees lo remove same upon notice Irom the . <br /> App o lor ons tl o�e City �repl ce lic property dameged the�eby. <br /> a-r�� -�� � 3 �� <br /> FINAL INSPECTION Date <br /> Approved as Constructed S n twe of Applicant �£' Dete <br /> WORK AUTHOHIZEU DY THIS PERMIT MUST BE ST�IRTED W�THIN � <br /> everett PUBLICWORKSDEPARTMFNT 180 DAYS OF DATE PERMIT IS ISSUED AND THEFiEAFTEfi IS TO '� <br /> � 3200CederSlreel BE DILIGENTL" PUFSUED TO COMPLETION. THIS PI°RMIT MAV BE '� <br /> Everett.WA 98201 CANCELL[D BY THE CITY UPON ANV STOPPAGE OF 1YORK ON THIS <br /> Phone�.259�8810 PROJECT OVER 90 DAYS DJRATION. <br /> I <br /> I <br /> I <br />