Laserfiche WebLink
l�J � � <br />ay <br />�C',�H <br />ayv� <br />, <br />H 3' <br />k n <br />H� <br />"�A H "i) <br />NH <br />y tg'' <br />� O tj1 <br />HC <br />��g <br />n� o <br />9H� <br />r z <br />HH <br />N <br />g�� <br />��Crrl <br />HOti <br />8a"'. <br />� s <br />� � <br />��'9,., � <br />Dale��� " <br />�� <br />M,ylication For <br />PUBLIC VIaI�RKS PERMIT <br />Print or Type Only <br />, a� � - _ <br />Owne <br />Applicant <br />Oescribe Proposed Work , <br />Projecl Address lil knowN <br />Atldress <br />Mai6ng Address <br />�:.:. <br />v��i�i�� �a��.,, �,,•:�`y c�— —/- <br />oine ocoi . ( ii�. _���V_ __ <br />{'uG4cWnnaice 5 <br />io�alfcr <br />less ApN Fcc Pa�� u <br />palaicrDue $ <br />Attach lour (A) copias ol pla�s lor proposed work � Draw to scale and nr.te �he lollowin9 as appliLal�IcJ <br />• Propeny Lines • Centerlme ol slreet <br />• Outlm�• a� �d dimensions of all existing antl • Indicate North <br />proi ��aa structures on the lot • Sho�v any proposed 9rading changes <br />•[xisimg and proposed utilities • Show mezsurements <br />PERMIT CONDITIONS <br />1. All calls for inspection shall be made 24 hrs. in advance - phone 2$9•881 O. <br />2. All work shall be pedormed in accordance wilh ihis peimit and ccrrenl City ol Everett Design and Conslruction <br />Standards and Specifications. <br />3. Call Lowtion Underground Service 48 hrs. betore you dic�. TOLL FREE NUMBER 1•800•424•5555. <br />lar Consiru�iion <br />FINAL INSPECTIJN <br />Approved as Cunstrncled <br />eveiell PUBLIC WORKS DEPARTMENT <br />� 3200 Cedar Street <br />Everelt WA 98201 <br />Phoni: 259�8810 <br />IL�i- -h����i r�� <br />Date <br />�,;lu /2 '/ 9-<5'3 <br />��� <br />W <br />� <br />� <br />� <br />Z <br />� <br />♦�^ <br />V�\♦ <br />\/ <br />a <br />ACKNOWlEOGEMENT OF CONDITIONS <br />The undersigned owner/applicant hereby agrces lo hold and save harm� <br />Iess Ihe Cdy ol Everelt Irom any antl all claims lor danmges, eosls. <br />ezpenses, or causes ol action that may aiise 6ecause ol installation <br />and maintenance ol Ihc impwvemenl or olher riyht�ohw;�y use herelo <br />applizd lor and lurther agrees lo remove same upon notice iwm Ihe <br />City and to replace puUlic properiy dama9ed there6y. <br />Signature ol ApPlicant Dale <br />WORK AUTHORI2ED BY THIS PERMIT MUST BE STARTED WITHIN <br />1B0 DAYS OF D�TF PERf.11T IS ISSUED AND THEREAFTER IS TU <br />BE DILIGENTLY PURSUCD TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON TIilS <br />PROJECT OVER 90 DAYS DURATION. <br />� <br />