Laserfiche WebLink
�� <br /> G�N <br /> ��� <br /> �+ �e ��,7� C� i <br /> .yay o Date� � �� :T-/ a�oe�wo,ksoa,m��. —����}1_�— <br /> O CC O rn qpplicalion For aing oea� < _ .___. <br /> '+tl H'�i �'.� <br /> �`°� PU�3LIC WORKS PERMIT v°°°�w°,�s�ee <br /> x ,o,r�FeP s— <br /> �o " <br /> �essAow Feevaia S <br /> ��b �� aa�a��d o�e : 20— <br /> Print or Type Onl� `��'. `�', <br /> 0 0 <br /> p� n o � r� <br /> H ., � w, <br /> �H� Gk���C� �, ���t�AKRo 4r3o r�p�.K ;o�c-r ��. ��`�r we• 9�a�3 25�i3]1� <br /> H�7 Owner ��; r_� o.� `� Marting Address City ip Phone <br /> g�°H � � w= � <br /> ��� C�€��G�� �/���`,�_u `f '�o `���-� Fti��sr a� Ea��'Er-, <br /> Applicant Mailing Address City 7ip Phone <br /> yo� LHr�✓ccf�P/N6 L <br /> DeScribe Proposed Work `�� .SJ��—_ <br /> W <br /> Prolect Adtlress(it known) � <br /> Attach four(4)Copies o�plan5 for proPosed work- Draw to scale and nnte the tollowing as applicable: � <br /> • Property Lines • Centedine of street /A <br /> • Cutline antl dimensions of all exis�ing and • Indicate North V� <br /> proposed structures on the lot • Show any proposed grading changes <br /> • Existing antl proposed utiiities • Show measurements Y <br /> iii <br /> �-� � �� DO NOT WRITE BELOW THIS LINE <br /> � � O��� PEPMITCONDITIONS <br /> ' ! � 1.All calls for inspection shall be made 24 hrs.in advance-phone 259•8810. � <br /> 1 ' 2.All work shall be performed in accordance with this permit and current City of Everett Design and Construction <br /> �� Standartls and Specifications. <br /> 3.Call Location Underground Service 48 hrs.before you tlig.TOLL FREE NUMBER 1•800•424•SPi55. � <br /> � � sS%�`-�t G1/LL �'L�- S!_:�rrJ�� ��a/� ���I �, <br /> � ! ` <br /> �S. �,�TL�v�GJ �'r'c�>c- C�/�f'�i� ��'T�-�J � �r/� <br /> ', �� �U.=�-J J��Tc,/ ��oiJC� <5'c�'�TiS� �'icr'���'/�' V♦ <br /> -�/�� � <br /> t ( �_ /7,i�i/J'Ty/� C,E'�S/O/7� C�/t�T.��L li <br /> , <br /> �••� G�riTf/ �S�,f'�9u>. <br /> � � ACKNOWLEDGEMENTOFCONDRIONS <br /> __ The undersigned owner/applicant hereby agrees to hoid and saee narm� <br /> � iess the Clty of Eaere�� (rnrti any antl all claims �or damayes. cos�s. <br /> � � expensas, or causes ot aCtion that may arise because of installatron <br /> � �tl maintenance of �he improvement or o�her riqht-oi-way use hereto <br /> `applied for antl furtner ayrees to remove same upon notice irom ihe <br /> App d for COnsiru ion n� - C��ry and to replace public property damagetl ihereby. <br /> �-�'/'b t�—�' i,Z - 3 �'> ,/�'��j�-,�,, I�//(]� �� � � � <br /> FINAL INSPECTION Date ��` H __. . <br /> Approved a9 Constructed Signatdr�ot Applic nt � Uate <br /> everett PU6LICWORKSDEPARTMENT �NORK AUTHORIZED BY THIS PEFM:T MUST BE STA9TED WITHW � <br /> � 3200CetlarStreet 1A0 DAVS OF UATE PERMIT IS ISSUE� AND THEREAFTER IS TO <br /> Everett,WA98201 BE DILIGENTLY PURSUED 70 COMPLETION. THIS PERMIT MAV BH <br /> Phcne:259-8810 CANCFLLEU BV THE CITV UPON FNY STOPPAGE OP VJORK ON THIS <br /> PROJECT OVER 9J DAVS DURAT:ON <br />