Laserfiche WebLink
i' <br /> Datf`���`� � PUUIic Kbrkf Permil+ �O� �'s� <br /> r•o Application For ema.oco�.� <br /> PU�LIC WORKS PERMIT PublicWorks(ee <br /> TotNFee S-- <br /> OLess ApP�-Feo Pa�d g <br /> C O O Balance Doe S ��OO <br /> Print or Type Only� o 0 <br /> p � � OOZ-32Z-yo- po0-/7-83/ <br /> �'1 CRtT 4�e1�l► � ���I FRt� AJ�• �U��"t �6zOy ���,z 7`jg3 <br /> Owner � �o N � Mailing Address Cdy Lp Phone <br /> � i orw <br /> C2��T �t� � G 3g�t F,���Y �� �u�.�'��r7' ���I 25��7?83 <br /> Applicant Mailing Address Ciry Lp �hone <br /> Describe Proposed Worh �CJ„ CNh1N �.INK F�t1���L /�2UUAI� � �'7l���S1��LS �F <br /> PD-cA�dL�Y A�uD At�'Snrn�infb �XisrrtitCr F� �ccrES ON c�'N2lL � S�OfiS aF CFR�f�K to7. ; <br /> W <br /> Project Address(il known) �� ~ � <br /> Attach four(4)copies of plans for proposed work• Oraw to scale and note Ihe following as applicable: � ? <br /> • Property Lines • Centedine ot street � �' <br /> • Outline and dimensions of all ezisting and • Indicate North � <br /> proposed structures on the lot • Show any proposed grading changes I <br /> • Existing and proposed utilities • Show measurements � � <br /> DO NOT WRITE BELOW THIS LINE O I <br /> PERMIT CONDITIONS � <br /> 1.All calls for Inspeclion shal�be made 24 hrs.in advance-phone 259•881 O. � i <br /> 2.All work shail be performed in accordance with this permit and current City of Everett Design and Construction <br /> Stendards and Specificationa � <br /> 3.Call Location Underground Service 4B hrs.hefore you dig.TOLL FREE NUMBER 1•800-424-5555. � i <br /> 1 <br /> .��, ��� �«�� ���a� �..� -�� ,���� - � <br /> _ �,. .� .�°� �c.�� �1i2���w ,��t� -n�c�— <br /> ,�� do l� ��� ��„ .�0� �ti. .�-�� ���� � <br /> �u <br /> oz�� �,� /t����c� a.l` �z�nz�io. xk�O��,,�, � <br /> � �� � � <br /> — a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees to hold and save harm� <br /> O� P�/` D�y���. ��d,�E/�q ' less (ItC City of Everett Irom any and all claims lor damages, costs, <br /> ezpenses. or causes of action that may arise because ol installation <br /> f � / �� , and maintenance of the improvemenl or other righPof-way use hereto <br /> 2�1 applied for and lurther agrees to remove same upon notice Irom the <br /> Approved for Constr ion Date City and to r�epJlac/e public property damaged thereby. <br /> / / ` ` // ,�V' � <br /> � ���� � �� �" O'% .25� <br /> FINAL INSP CTION Date � Date <br /> Approved as Constructed Signalure of Appl ca t <br /> WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> everett PUBLIC WORKS DEPARTMENT 1B0 DAYS OF DATE PERMIT IS ISSUED ANO THEREAFTER iS TO <br /> � 3200CederSireet BE DILIGENTLY PURSUED TO COMPLETION. TH�S PERMIT MAY B[ <br /> Everelt,WA 98201 CANCELLED BY THE CITY UPON ANY�TOPPAGE OF WORK ON THIS <br /> Phone:259�8810 PROJECT OVER 90 DAYS DURATION. <br />