Laserfiche WebLink
i <br /> � <br /> Date�� ~ �um�c Wort�ve�mn• � � 9� <br /> � •n ApplicBtion For emc o�ni • _ <br /> PU�LIC WORKS PERMIT P�°;o„�;�`°° : — <br /> � <br /> UO lees�ppl Poe Pe��l S <br /> Print c Type Onl� � � B.�•�«o�� s 24� <br /> ? � p �'r' 33�/-�G(o 76 <br /> /I7]� " i �� � �Bs�-iD�a <br /> wner � Mailing Adtlress Clty Zip Phone <br /> � iy�rN� QA� ��t9-/OGd <br /> Applicent Mniling Address Clty Zip Phone <br /> /� 'P� �'rom J, � <br /> Dee rlbe Propo ed Work ��� /1/ /7���/� 17 J � � I �. <br /> / i <br /> �; ,��Cl1�L1�1B tar/_c__L�ii�� �12�L� 412// G��i�/, <br /> i _� ' <br /> � Pro�ect Address lil knownl �� � �L � — � � <br /> � <br /> Aflach lour(4)copies ol plans lor proposed work� Draw to scale and nole ihe lollowing ns apphcable: � <br /> � • Properry Lines • Cenleiline ot shee� � <br /> • Outline end dimensions of ell exis�i�g and • Indicale Narth <br /> . proposed slructures on fhe lol • Show eny proposed�radmp changes <br /> � • Exlafing and proposed utllities • Show meas�remenls � <br /> ; DO NOT WRITE BELOW THIS LINE <br /> � PERMIT CONDITIONS O <br /> � 1.All calle lor Inapection shall be made 24 hrs.In advance-phone 259•8810. � <br /> 2.All work ehell be peAorm�td In ac^ordence wllh this permll end currant City of Everett Design and Conatmctlon <br /> Stenderds end Specllicetions. <br /> � 3.Cell Locatlon Underpround Service 48 hrs.before you dig.TOLL FREE NUMBER 7•800•424•555b. � <br /> i O ' <br />;.�i � � 'i <br /> s;, � � ill <br />:�:: � O <br /> ? ; a <br /> ACKNOWLEDGEMEN7 OF CONDITIONS <br /> �„ The undersigned owner/applicenl hereby ngrces to hold and save herm- <br /> less Ihe City ol Everelt Irom any and ell claims lor dameges, cosis, <br /> . expenses, or cnuses ol ection ihat may arise hecause of installation <br /> ���� � � pO anA main� ance of ihe impiovement m other nghl�obwey use heralo <br /> -- � applied lo nd lurther agree o remove se e upon notice Irom �he <br /> Approvad 1or Con r ction / / Date Cily and I r place pubGc pr rty dar::.�e ereby. <br /> /���� /%� � 1"' 3'f/ _ !1 /i,_Qh <br /> FINAL INSPECTION Date ��� <br /> ApprOved ae Conatrucled gntilure ol Appl�cant Dale <br /> everett PUBLIC WORKSOEPARTMENT WORK PUTHORIZED BY THIS PFRMIi MUST BE STARTED WITHIN � <br /> 3200Ceder5lree� 180 DAYS OF DATE PERMIT IS ISSU[D AND THEREAFTER IS TO <br /> [varett,WA 80201 BE DIUGENT�V PURSVED TO COA�PLE710N. THIS PERM�T MAY B[ � <br />�"::� - Phone:259�8810 PROJECT OVER 90 DAYS DUR 710N STOPPAGE OF WORK ON THIS <br /> I <br /> � <br /> I <br /> I <br /> ! <br />