Laserfiche WebLink
�y � M <br /> � //�/f-�+/�� . <br /> 10 C �8�e�� .`L�•� V� � PuLI�cWwMPmm n_'�_. —_ <br /> �. '3 H APPlication For o�aa oeo�.+�_ •'. '. =_��-; . <br /> K � � PUBLIC WORKS PE��"JIIT Pu�Tot�Fler� s - <br /> �3 %� <br /> roH � �e..aoo�Fee v.�a S <br /> N M <br /> � � �" Print orTypeOnly eai:��ao�e S <br /> o .+ <br /> � <br /> � '° �p (��.f� � , ��� , �L't`� ►�l',ll�l<i. �� G';il"l� ���:���, � 'k—�. I�7� <br />� y ri T�� Owner MailingAddress Gry Z�.p Pnone <br /> � y 'L <br /> H H / �� <br /> y � �.1 M1 l �� <br /> M <br />� o N Applicant MailingAddress C:ty Zi, Fncne <br /> I � °artq <br /> O tyr� Describe Proposed Work ��-��/L� � YG�y��� <br /> I <br /> Project AGtlress pl known) `^J a�� _ � <br /> Altach lour 14)copies ol plans lor proposed work-Draw lo scale and note the lollowing as applicablr: � <br /> • Property Lmes • CeNerline of street /^ <br /> • Outline and Aimensions of all ezisting and • Indicale Norih V� <br /> proposetl 6lructure6 on the Ipt i Show any proposed 9iaoing chanqes <br /> • Existing and p�oposed utifities • Show measmemenis � <br /> DO NOT WRITE BELOW THIS LINE <br /> I �� PERMIiCONDITIONS O <br /> 1.All calls lor inspection shall be made 24 hrs.in a]vance-phone 259•8610. � <br /> 1 2.All work shall be pedormed in accordance with this permit and current City of Everelt Design and Consl�uction <br /> _ Standards and Speciiicalions. <br /> � 3.Call LocaUon Underground Service 48 hr;.before you dlg.TOLL FREE NUMBER 1-800•424•5555. � <br /> !�� <br /> �__ O <br /> � �r� � /� � n '_� � <br /> � ��r.t-lflm�'� y��z��=-� ��Jo {'.�,�-', 9 � ?s <br /> � <br /> � � i� <br /> _,1�'� �;�� (� <br /> _ - - __ , 0 <br /> ? �`���� �,,.�. ,�„� � o. <br /> ---� ' � � �,,� � .� s��/- � ' <br /> � ---_ __ _ . <br /> O�� __ - �� ACKNOWLEDGEMENT OF CONDITIONS <br /> li � ' 1 � Theundersignedownedapplicantherebyag�eestoholdandsaveharm� � <br /> � �� less Ihe City ol Everett Irom any and all claims br damages, cozls. <br /> �. expenses. or wuses ol action that may arise because ol installation <br /> and maintenance ol ihe improvemeN or other iight�of�way use berelo i <br /> applied lor and further agrees lo remove same upon nolice irom the <br /> Appwved for Construction Dale City and to replace public property damaged thereby. <br /> fINAL IIJSPECTION Date <br /> AnP�oved as Conslroctetl Signalure ol AFPlicant Date <br /> everp�� PUBLICWORKSDEPAflTMEM WORK AUTHORI2ED DY THIS PERMIT MUST BE STARTED WITHIN <br /> � 3200CedarStreet 1B0 DAYS OF DATF PERMIT IS ISSUED AND THEREAFTER IS TO <br /> [verett,WA 98201 �� DILIGCNTLY PURSUEU TO COMPL[TION. THIS PGI7IdlT MAV O[ <br /> Phonc.259�e[310 CANCLLLED�V THE QTY UPO�J AIJY STOPPAG[OF\NORI<CN THIS <br /> PROJf_CT OVER b0 D�YS UU17A710N. <br /> � <br />