Laserfiche WebLink
� <br /> �BtPn� PuGuc Wo�xa Perm�• — /�L <br /> Application FOf eiep Oeo��• <br /> PUBLIC WORKS PERMIT °�t�KW��.�� - <br /> TMe�Fee s <br /> Ll664pp1 fB!PlIE s� <br /> Print or Type Only BelenceUue s .-'�C�—� <br /> ('���"I ��y /S � � ��-L��j G G<.e�,� �;�� G / - � S � - �� 9� <br /> Owner // Ma�Bng Adtlress / Ctly Zip Phone <br /> V <br /> �.e{, JZ� �;��+--� <br /> Applic.nt Mailing hdtlress C�ty 2in Phone <br /> Describe Proposed Work ���'��� <br /> -�r.�-¢--d �-�e��.-c� ( --�-�� <br /> � � ii , . <br /> �7 nI'ics�C LJ S�fn � ( " c/i...-�h� ,��,61ia s�c��lk W <br /> Prolect Address lil known� ���,'— C��c=id/ /�!Y_- � <br /> P.ttach lour(4)copies ol plans for proposed work- Draw to scale and note ihe following as apPlicable: � <br /> • Property Lines • Centerline ol sireet � <br /> • Outline and tlimensions o�all?zisting and • Indicate Norlh <br /> propose0 strudures on the lot • Show any proppsed gratling changrs <br /> • Exlstins and p�oposed utilities • Show measurements � <br /> DO NOT WRITE BELOW THIS LINE <br /> PERMIT CONDITION5 O <br /> 1.All r.a�ls for inspectlon shell be made 24 hrs.in advance-phone 259-8810. � <br /> 2.A�I work shall be peAormed in accordance with this permit antl current City ol Evnretl Design and Construction <br /> Standards and Spedfications. <br /> 3.Call Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 7•800-424•5555. � <br /> 7�, �JNS:;C'c�cT ��x! iti L��c�;��,r/ ,�._,;�% ��i' _'�i_���s;^ O <br /> G 'BAI,f- ��� 6/��.f eF S•n_.�-�d�9�.0, <br /> � <br /> .� Q�//✓�,c" �S1<'/''iCl ,ts',� /F'�.(f'Oillc/�I._� %� ' /,�.��,,��.� � <br /> %�/C` Fn�E /F T�/.� ('iT� J'rf�c>./� i) ;d• i' O <br /> N�so T� �as� Ti� ��<„�r _vF- l�/�'�- a <br /> ACKNOWLEDGEMENT UF GONDITIONS <br /> The undersigned owner/app�icanl hereby agrees to hold and save harm� <br /> less the City ol Everett Irom any anA all claims for damages. costs, <br /> .� expenses, or causes ol action that may arise because ol installafion <br /> �� �„"; /�,�� �� ��� and maintenance of the improvement or other righl-ol�way use hrieto <br /> ApDroveC for Consiru ti Date a��lied lor and lurther agrees to remove same upon notice Irom ihe <br /> Ciry and to replace pubLc property tlamaged thereby. <br /> / <br /> ` d� .T/� '�� � /' � <br /> FINALIN PEGT�ON Date Y ���"u.� �.��-r7�.(�� <br /> Approved as Constructed Signalure ol Applicanl , Uate <br /> everett PUBLIC WORKSDEPARTMENT WORK AUTHORIZED BY TFiIS PERMIT MUST BE S7ARTED WITHIN <br /> � 3200CeAarStreet 180 DAYS OF DATE PERlAIT IS ISSUED AND THEREAFTER IS TO <br /> Everett.WA8B201 8E DILIGENTLV PURSUEf) TO COMPLETION. THIS PERMIT MAY BE <br /> Phone:259-9810 CANCELLED BV THE CI?`/UPONl.NY STOPPAGE OF WORK ON THIS <br /> PROJEGT OVEF 9b UAY3 DURATION. <br />