Laserfiche WebLink
HC�H <br />� CrsJ 'i1 <br />� � � <br />C H <br />9HCn <br />��� <br />H 7tl <br />� N � <br />� H <br />L1 O � <br />OH <br />��g <br />�1] Y (7 <br />C"y� <br />Hy <br />gy <br />H <br />C7 �1 p� <br />� � [s1 <br />HOf�i� <br />-•� <br />; <br />PWhe . <br />` <br />I <br />� <br />Date�/ � �� <br />Application For <br />PUBLIC WORK:.� PE,P.?VI-T <br />Print or Type Only <br />Owner <br />City / Zip <br />Vu�i¢ Woixs Pe�mit • ��� �� � <br />BiC9. Deal.+' �/� ' — <br />r�erc wa�xs Feo 5 <br />Tulal fce <br />Lefs A00� fea Pu�tl $ _. <br />�alancv �u[ g <br />Describe ProPosed Work /Q1S.pn � 1]� 0?/✓0lkia �j1c(M?:J�/•'12�crn ��i2n��0 CQl <br />Project Address (if known) <br />Attach lour (4) copies o( plans lor proposed work - Drew to scale and note the following as applicahle: <br />• Properly Lines • Centerline ol street <br />• Outline and dimensions ol all existing and • Indicate North <br />proposed st�uctures on the lot • Show any proposed gradin9 changes <br />• Existing and proposed utilities • Show measurements <br />PERMI'f CONDIiIONS <br />1. All calls (or inspection shall be made 24 hre. in advanse- phone 259•8810. <br />2. All work shail be peAormed in accordance wilh this p�rmit and current City ol Everetl Desic�n and ConsVuction <br />Standards and Specilications. <br />3. Call Location Underground Service �18 hrs. before you dig. TOLL FREE NUMBER 1•800•424•5555. <br />�o ���1�� \�orks -I�erm�t, re��.,lr'ec�. <br />Approved lor Construction <br />4-��-9� <br />j?�,,.s'_ vt���� <br />�ate <br />PINAL INSPECTION �a�e <br />A�,,p;nved as Consiruc�ed <br />everett PUBLIC WORKS DEPAR7MENT <br />� 3200 Cedar Slreel <br />Everetl, WA 98207 <br />Phone:259�8810 <br />�� <br />♦r� <br />V♦ <br />� <br />a <br />ACKNOWLEDGEMENT OF CONDITIqNS <br />Thc undersi9ned ownedapplicant hereUy agrees to hold and save h,;rm� <br />less ihe Ciry ol Everetl Oom any and all claims lor damages, costs, <br />expenses, or causes of aclion that may arise hecause of installa�ion <br />and maintenance of Ihe improvement or other ric�h4of�way use hereto <br />applied lor and luriher agrees to remove same upon notice trom ihe <br />City and m replace publir. p�operty damaqed thereby. <br />Signalure ol Applicant Date 'i <br />WORK AUTHURIZED BY THIS PERMIT MUST BE STARTED WITHIN ' <br />180 DAYS OF DATE PERA1lT IS ISSUEO AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY B[ <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PFiOJECT OVER 90 DAYS DURATION. <br />� <br />a <br />