Laserfiche WebLink
yr � <br /> ;r'. -ii,� <br /> � ouo�,:wo,w.ve.mn. <br /> � � � Date;�lS�1� .F3� /�1� '�' <br /> e�aa oe��..T <br /> � h y Applicatw�For <br /> ; �� PUBLIC VI(ORKS PERMIT '"`t�wFe:"° S <br /> K y � � i.�.�ooi.r�e v.�e S <br /> Oa�enceDue E �C �� <br /> � c~i� r-�i Print or Type Only !'G,'G I <br /> z <br /> � y� / / / � ` f� i�� 1��� 9s;r7'�' 353 -z7c i I <br /> ///JN1�]7�CL vr ef 7L�6 /c Z� Phone <br /> Ld n�7 Alading Aaaress � <br /> H/� t�7 O Owner i <br /> ^.V �] /� ! <br /> H - / / / �4s� I� L`Itw � — .- '.yZ L <br /> z y� �'y/�/i��n ».7KcZ /ouf/� 7LYt /C � /fs'Z �'Sa,7 7^/ <br /> � CitY G Phone <br /> ApP���a�� M Jing Address <br /> �-+H <br /> y H r��« �0„�, <br /> g�y � <br /> a Describe PwPosed Work � <br /> Zytn <br /> y � �' W <br /> v _ / Y_ � <br /> Pmjed Address(il known) � <br /> � <br /> Atlach feur(4)copies of plans for proposed work-Oraw to scale and note the lollowing as applicable: � <br /> • Property Llnes • Centerline of streel i <br /> • Outline and dimensions of all exisiing and • Indicate Norih � <br /> proposed slruCWres On thv lot • Show any proposed grading changes <br /> • Eaisting and proposed utilities • Show measurements /� <br /> W <br /> DO NOT WRITE BELOW THIS I.INE O � <br /> i PERMITCONDITIONS � <br /> t. All calls for inspection shall be made 24 hrs in advance-phone 259•887 5. <br /> i�� 2. All work shall be perlormed in accordance with ihis permit and current City of Everett Design and Go��slruction <br /> I Standards end Specifications. � � <br /> 3. Call Location Underground Service 48 hra.before you dig.TOLL FREE NUMBER 1•800•424•5555. <br /> 1 .. � y jt- 6'E !c�✓sT.cc;•Cf�� �E.e A�i-x^n✓6�� � <br /> !,_�1 f'«,c,� v��;�o y-.'._ - ,s�� . <br /> - � <br /> � �-� � V) <br /> 0 <br /> ,-- a . <br /> a�� <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> ��� The unCersigned ownedapplicaM hereby agrees to hold and save harm- <br /> less Ihe City ol Everett Irom any and all claims 1or damages, cosls, <br /> '� • ezpenses, or causes o1 action ihat may arise because ol instellatfon <br /> �' ��� ���35 and mai lenance ol the improvemenl or other righ4of-way use hereto <br /> -'=, � app�ie f r a furt er agrees to remo� same upon notice from the <br /> Approved��struclion Date pi�y nd o -PI c ublic prope y da ed thereby. <br /> � � -/.`-� 3 j y i <br /> FIt�AN TION Date _� "� Dale <br /> Approved as Conslructed Si nature plicant <br /> WORK AUTHORIZED BY I PEPMIT MUST 6E STARTED WITHIN <br /> Oevcren PUBLIC WORKS DEPARTMENT 1g0 DAYS OF DATE PER I IS ISSUED AND THEPEAFTER IS TO <br /> 3200 Cedar Sirr.et BE DILIGENTLY PURSUED O GOMPLETION.THIS PERMIT MAY BE <br /> Everett.WA 98201 CANCELLED BY THE GTY PON ANY STOPPAGE OF WORK ON THIS <br /> Phonr.: 259-�F315 PROJECT OVER 90 DAYS DURATION. <br />