Laserfiche WebLink
�-�1� / �`�% -/..��' <br /> Date �,�,�,���o,�.P� /��/ <br /> • 5�na Deo� -✓����- - <br /> Applicahon For <br /> PUBUC WORKS PERMIT P•bTolaiorFf` 5-- --- -- --- <br /> lessAno� fee Pnia 5 <br /> � � OalanmDuc $ �CO� _ <br /> Print or Type On�y <br /> � y ` r��� r�n���-��G�.�C�a�'�P� 1�� �c�� ��-�i� 1 <br /> ��, �,'� '� Madmg Atltli ss C�ty 7ip Phone <br /> Owner <br /> ��� �noP���an, Maihn[�Atldress Giy Lp Phone <br /> ��Q �` �� t� <br /> N d Descnbe ProPosed Worh — <br /> Qr (� <br /> � y� W <br /> M � � <br /> W Pro1ed Atldress I�1 knownl <br /> H <br /> �� qtlach lour 1�1 cop�es of plans for[�roposed wo�k� Draw to scale�ntl note�he�ollowing as applicab�e: � <br /> • Properry lines • Center6ne of street � <br /> • Outlme and dimensions ol all existin9 nntl • Intlicata Norlh <br /> ��q pwposetl structures on tlie lot • Show any pmposad grad�ng chnnges <br /> • E�isung and proposed ulihtirs • Show measuremCnis M <br /> �� DO NOT WRI1E BELOW 1HIS LINE O <br /> � PERMIT CONDITIONS <br /> � 1.All calls for inspeclion shall6e made 24 hrs.in advance-phone 259•88�0. � <br /> I �_ 2.All work shall be perlormed in accordance with this permit and current City ol Everet�Design and Construction <br /> L ' Slandards and Specilications. <br /> � 3.Call Location Undeiground Service d8 hrs.6elore you tlig.TOLL FREE NUMBER 1•800�424•$555. � <br /> r O <br /> � _ <br /> � <br /> -- <br /> N <br /> O <br /> i <br /> �_�_� G' <br /> ,_� ACKNOWLEDGEMENT OF CONDITIONS <br /> `�1� Tho undersi9ned owner/applicant hereby agrees to hold and save harm� <br /> less Ihe Cdy of Everetl Irom any and all claims lor tlama9es, costs. <br /> expensr.s. or causes ol action thnt may arise because ol inslallation <br /> !� r % f� �� � �J and mamtenante ol Ihe �mprov�ment or olhcr ngM-ol•way use hereto <br /> applied lor and further agrees to remove same upon notice trom Ihe <br /> Approved lor Const uction � ���� C�ry and to replace public pwPerty dama9ed Ihereby. <br /> rn-��� � ,r <br /> FINAL INSP[CTION ���e Datc <br /> Approved as Constructed Siqnature of App i an1 <br /> WORK AUTHO IZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> everett PUBLICWORKSDEPARTMENT 180 DAVS OF DATE PERM11IT IS ISSUED AND THEREAFTER IS TO <br /> � 3200 Cedar Slreet gE DIUGENTLY PURSUED TO COMPLE710N. 7HIS PERMIT MAY BE <br /> Eurolt,WA 99201 �,�r CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone:259�8810 PROJcCT OVER 90 DAYS DURATION. <br />