Laserfiche WebLink
,; � � <br /> PUBLIC WO KR S�ERMIT D81e ��g��� <br /> PUBLIC WOFlKS DE(�/1R��Bfi Public Nbrla PermR N -1 S��7� <br /> szw c,�a�.su..e W <br /> E�ren.wn eexoi 2s�9ai o a,�an�y�nn• <br /> � - <br /> TYPE OR PRINT ONLY •ro p o o PubNc Nbiks Fee S ZD' <br /> h� UO � <br /> Gc�t�i 13�uc. p.o F�� � LYNNw.�ee. �wit. �r�G (sas) Z�+G•�i3 <br /> Owner AAaINrq Addiess ¢ City 7Ju <br /> C4l�aX s��srf 'i�t�e N�S��rrc L� � WA ?AM� ��)t�o��s! <br /> APP�k:ant MaNMNAddress oa o f"' Oity Zlp Phone <br /> Describe Proposed Work Q�/L�i�r �� r�'I�VCI �R/Ll1/a �'r a'� � <br /> � � <br /> � <br /> � <br /> PROJECT ADDRESS(if known) �EVG� YY.Gn V1� � <br /> Attach four(4)copies of plans for proposed work-Draw to scale and note tM.lolbwing H epplicable: <br /> •PropaAy Lines 'OWline and dimenslons of ali az�sting and proposed structures on the bt 'c.uistlng and proposed u111Hiea O <br /> 'Centerline of street •Indkete NoAh 5how any proposed greding chenges 'Sha.v measurements � <br /> DO NOT WRITE BELOW THIS LINE <br /> PERMIT CONDITIONS: Z <br /> 1.All calls for inspection shall be made 24 hours in advance-phone 259-8810. � <br /> 2.All work shall be performed in accordance with this pertnR and current City of Everett Design and <br /> Constructinn Standards and Specifications. <br /> 3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800-424-6666. H <br /> 4, �s � �Pp�.�d P i�,,1 ��6 G�r 7 f qs. � <br /> 0 <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owneNappllcant hereby aQrees to hokf and save harmless <br /> /7 8 the City of Everett from any and all claims for damages,costs,ezpenses,a <br /> proved lor C siructi � Dat ceuses of aetion thal may erise because of Instelletbn end malntenence o1 <br /> � � thefmprovementorotherrigM-o(-wayuseheratoappliedforandfurlherap'ees <br /> to rertave same upon noUce 6om the City and to �eplece pudic property <br /> ' : /�-�7• damegedthereby. <br /> FINAL INSPECTION Date <br /> Approved as Constructed <br /> � � <br /> Signature ot cant � Dete <br /> WORK AUTHORIZED BY THIS PEHMIT MUST BE STAHTED WITHIN 180 DAYS OF DATE PERMR IS ISSUED AND THEREAFTER IS TO BE DILKiENTLY FURSUED TO <br /> COMPLETION.THIS PERMIT MAY BE CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS PRQIECT OVER 90 DAYS WRATION. <br />