Laserfiche WebLink
.� ' �vaR�< . eW.aa.[ <br /> ' '-' 1 �a P„� �wo„b va, 8� /.32 <br /> Date�LL� I �x� i 7'�J�J <br /> AppliCa�ion Fcr Ninq Depi . . :S-1 I_{��J�j['� <br /> _I <br /> PUBLIC WORKS PERMIT °°°��°w°,kSGee - <br /> io�al fee S-.— <br /> Less Appl.F9e Px�O $— <br /> 2� <br /> Baiarce Due S_ <br /> Print or Type Only — -- <br /> ��n�► ��� CD ���'s 5'��' ,� ar�l l�lV! l� <br /> Cwner MaJmg Address City Zip Phone <br /> _ �'U�� -�-E�s10-7�,� <br /> Apphcant Mailing Address City Zip Phone <br /> DescnOe Proposed Work ��� � ���� - <br /> �/ ,/ W <br /> Proiect Adaress(if knowN —7�3r — ��AC/�" FL�iE'fST.��• . � <br /> Attach four 14)copies of plans tor propoaetl work- Draw ro scale and note the following as applicable: � <br /> • Pwperty Lines • Centerline ot sireet � <br /> • Outline and dimensions of all existing and • Indicate North <br /> proposed structures on the lot • Show any pwposed grading chanoes <br /> • Existing antl p,oposed utilities • Shuw measurements � � <br /> DO NOT WRITE BELOW THIS LINE � <br /> PERMIT CONDITIONS <br /> 1.All calls for inspection shall be made 24 hrs.in advance-phone 258-8810. � <br /> 2.AII work shall be performed in accordance with this permit and current City of Everett Design and Constructicn <br /> Standards and Specificationa <br /> 3.Cail Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1-800•424-5555. � <br /> � <br /> h <br /> V� <br /> O <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> � The undersigned owner/2ppiicant hereby agrees to hold and save harm- <br /> less the City o� Everett irom any and all claims fcr damage�. costs. <br /> � / expenses, or causes of acti.n tha± may arise because of installetion <br /> �/�q%� O /1 �/G�`� and m �ntenance of the imProvement or o�her ri9h��o�-waY use heieto <br /> 1(/LT��JOb�y1� T^ appf for and turther agrees to remove same upoc notice from the <br /> PD�oved for Construction Date City a tl ro replace public pr�perry da aged thereby. <br /> B��'7-6� <br /> NAL INSPECTION Date � <br /> �proved as Constmcted Sigrature o(Applicant Date <br /> WORK AUTHORIZFD Y THIS PFRMIT MU3T 8E STAFTED WITHIN <br /> everet[ PUBLICWORKSDEPARTMENT 1g0 DAYS OF DATE FERMIT IS ISSUED .4ND THEREAfTER IS TO <br /> � 3200Cetlar Street BE DILIGENTLV PUFSUED ?O COMPLETIUN.THIS PERMIT MAY BF. <br /> Everett,WA 9A201 CANCELLED BY THE GTV UPON ANV STOPPRGF OF WORK OiY THIS <br /> Phone:259-8870 PROJECT OVER 90 DAVS DVPA'ION. <br /> .� <br />