Laserfiche WebLink
� <br /> r '� <br /> i89 <br /> oate � �7 gs P�o���Wo�k,Po,m��. RS- t�' <br /> eiae�oev��� <br /> ' Applicatlon For <br /> PUBLIC W�RKS PERMIT PubTo�FeeFee $ <br /> fT� <br /> �ess nPot Fee aeia $ . <br /> Belanta Due $ �z�� <br /> Print or Type Only Q� �' 7 <br /> B H Yn� l�earv►� ir� P D 8ok 7�Z�. S-�N����1 ��ga9�2 �24-aas <br /> (► �P YYJ14ST�'R 770 C�i�o wN ,Or �I/e�P�'� 9S�v/ ._ 3S��lY� <br /> Owner Mailing Address City Zip Phone <br /> �-i�N �/�ofo r5 ��OD EJ�ra re.etti N�V_ c�'ver� /tc A •9F�a3 353-7/7/ <br /> Applicant Mailing Address � Gity Zip Phone <br /> .� - �7 <br /> .,�q �� o_� ,�,� ti�, � ,•l /�f <br /> Describe Proposed Work /� e �l'�"/r d �t"` / r'�'� r <br /> l,YL/� �/1 l�Pi��GC � ���� <br /> � <br /> Prolect Address(it known) �a�� G���YP-P � <br /> v � <br /> Attach tour(4) copies of plans for proposed wor�,- Draw to scale and note lhe following as applicable: � <br /> • Property Lines • Centerline of street <br /> • Outline and dimensions ot all existing ar.d • Indicate North <br /> proposed slrucW res on the lot � � Show any proposed grading changes <br /> . • Existing and proposed utilities • Show measurements M <br /> W <br /> I, n�+� DO NOT WRITE BELOW THIS LINE O <br /> � PERMIT CONDITIONS <br /> 1. All calls tor inspeclion shall be made 24 hrs, in advance- phone 259-881 5. � <br /> � 2, All work shall be per(ormed in accordance wi�h this permit and current City ol Everelt Design and Construction <br /> Standards and Specifications. <br /> 3. Call Location Underground Service 48 hrs. belore you dig.TOLL FREE NUMBEA 1-800•424-5555. � <br /> � <br /> � ,.oi�',�,��y ���Ps � ��= ,���,��� o� � �} <br /> .�.�i�'h'�c-- ��,E'c��G,E'i� — �l�T �i✓ �c.�B.cl� <br /> � c9. !�r �uTT/iJG �l/���.E�� ��� V♦ <br /> O <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees to hold and save harm- <br /> less Ihe City ol Everett Irom any and all claims for dameges, costs, <br /> � expenses, or causes of action ihat may arise because of installation <br /> � and mainlenance of lhe improvemenl or other righFoi-way use hereto <br /> applied for and furlher agrees to remove same upon notice from the <br /> Appr for Cons lion Oate City and���+replace public property damaged thereby. <br /> ' " _ y. <br /> �'-�_�i' /'- ,r�.�-,�:ST f��2� ii.,-. h��- CvIr7I�S` , , <br /> ,:�..` /'�,.+> . <br /> INAL,INSPE TION� / Date Date <br /> Apprdved as Co�iructetl Signature of AP licanl <br /> � VJORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> everett PUBLIC .JORKS DEPART:v1ENT 1B0 DAYS OF DATH PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200 Cedar Street BE DILIGENTLY PURSUED TO COMPLETION. THIS PEFMIT MAY BE <br /> � Everett,WA 98201 CANCELLED B`!THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone: 259-8815 PROJECTOVER 90 DAYS DURATION. / <br />