Laserfiche WebLink
� i <br /> "l <br /> Il <br /> II �BtQL(« Pu�ilc Worxa Permit� �-�J c J�t% <br /> Application For eiee-oeai r <br /> PUBLIC WORKS PERMIT P��I�cWorkaFee <br /> Total Fee S <br /> less POP�Fee PaiO S <br /> Print or Type Only BalenceDue s �U.L70 <br /> 79 f �S <br /> /LI t-d�� G�rar-e� ��o !'i�. r'/e.� ��- '��J�ryet�- <br /> � C• �`fo� 3S-S=�73 7 <br /> Owner Mailing Address ity Zip Ph�ne � <br /> .-� <br /> ��/1tP �.'�. <br /> pplicant Mailing Address City Zip Phone <br /> �' -�-i � <br /> Describe Proposed Work ,�f�r�a lT r1Ti�l���.�SO /�J�6� � ���T?�ro�+ T— N = <br /> , <br /> /do���..+��J� � o <br /> ' %l r "'� <br /> /ir s� �.��s�,�, '� r/'y.�.d Y/,o�p �.�u �:r����. SY' "� �� <br /> ProJect Address(if known) �Z�Ll� �� 7��l���c��Lf.���X1�r��//� ( � � m � <br /> .o z <br /> Attach four(4)copies of plans for proposed work- Draw to scale and nole lhe following as applicable: � cn � <br /> • Property Lines • Centerline of street � r x <br /> • Outline and dimensions of all existing and • Indicate North �N <br /> proposed structures on the lot • Show any proposed grading changes � <br /> • Existing and proposed utilities • Show measuremenis � o � <br /> � <br /> DO NOT WRITE BELOW THIS LINE O = m <br /> PERMIT CONDITIONS m ~ <br /> N <br /> � <br /> 7, All calis tor inspection shall be made 24 hrs. in advance• phona 259•881 5. � m i <br /> 2. All work shall be pertormed in accordance with this permit and current Ciry ol Everett Design and Construclion � 3 N <br /> Standards and Specificationa m <br /> 3. Call location Underground Service 48 hrs. before you dig.TOLL FREE NUMBER 1-800•424•5555. � �m <br /> n <br /> 5! �'aT<ry ��Si�/ h'G'ST BE Ao�'vsTEo Y GK'QDE O A <br /> BY AI��'CiG�In,�T. x <br /> a <br /> 5 CiJTC�( B4:Si/l� _ <br /> S.. AE'EA mt•s7' [�� e-.c�QOF� 7c i�,ea..0 To ■ -{ <br /> r � <br /> � N <br /> 2 <br /> O O <br /> --I <br /> n <br /> m <br /> a <br /> ACKNOWLEDGEt,AENT OF CONDITIONS <br /> �(, The undersigned owner/applicant hereby agrees to hold and save harm� <br /> less the City of Everett from riny and all claims for damages, costs, <br /> - / J expenses, or causes of action that may arise because of insta�lation <br /> C-� / � /� N��/5,� and maintenance of lhe imprevement or olher right-obway use hereto <br /> %1��� _ G>t'T�7 7% applied for and furiher agree; to remove same upon notice Irom the <br /> Approved for Construction � D e City and to replace public property damaged thereby. <br /> ;%:��a;���� z _�_�-� � � �J p <br /> FINAL INSPECTION Date �'�h / �� A� <br /> Approved as Constructed ig aWre of Applicant Date <br /> PUBLIC WORKS DEPARTMENT WORK AUTHORI2ED 8Y THIS PERMIT MUST BE STARTED WITHIN <br /> everett 180 DAYS OF DATE PEFMIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200 Cedar Street BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMiT MAY 8E <br /> Everett,WA 98201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone: 259-8815 PROJECT OVER 90 DAYS DURATION. <br />