Laserfiche WebLink
� <br /> , <br /> .,.X�.f ; <br /> � � ; <br /> ����� .� t �MhSL�\I <br /> l' <br /> Q 2a: <br /> ��� l� �, ;� .. .. .. � . .,. . � <br /> � '� C:�'i 'S <br /> � �� oace� '7�"�� �i 2� i <br /> a�oo�wo�k�v��mn. <br /> � ni APP�ication For eiea.oeo�.• � <br /> � �� PU��iLIC WORKS PERMIT PoELCWorkeFee <br /> � Tolel Fee S <br /> � �� � TO POSTING lD �"°��Do�FxePalEs O � <br /> M � O p L� O O tn Belenca Due S Zd'� <br /> p� n � Print or Type Only� �; � �'• �n r� � <br /> H � + or; � om /�/� <br /> Z y� o `n. �� r� „• ri m �J�'�d�- <br /> / �l 1� !I� ..S yl ;p � <br /> g � Sz«�i. !�c�,� 5/.ac - �s'`� � .c% /Ia.�f�pl�J/� �a7o <br /> `p H owner <br /> � �r� � �AA�'Np9 Address CitY Zip Phonu <br /> (] W j o- ome� rl � � <br /> ��� � O � � J � N � `G . <br /> ,(�1,�� x ,L il d Lil O Ll � <br /> Applicant Mailing Address City Zip Phone � <br /> � Describe Proposed Work � ���i Jl <br /> C <br /> � Prolect Adtlresc(i1 known) ��(/ � � � <br /> � Atlac�four(4)r.opies ol plans for proposetl work- Draw to scale and note the lollowing as applicable: � � <br /> • Property I ines • Centedine of street � � i <br /> . • Outline end dimensions ot all ezistinp and • Indicate North <br /> , Froposeo structures on the lot O Show any proposed grading changes <br /> • Existing and proposed utilities • Shcw measu�ements � I <br /> � � DO NOT WRITE BELOW THIS LINE O <br /> ���1 I I <br /> PERMIT CONDITIONS <br /> .'� I 1,All r,ail5lor inspec�ion shell be made 24 hrs.in advance•phone 259•B8�O. � � <br /> � , 2.All work shall be perlormed in accordance with�his permit and current City ol Everett Design and Construction <br /> Slandards and SUacifications. <br /> . �� � 3.Call Location Underground Se;vice 48 hrs.belore you dig.TOLL FREE NUMBER 1-800�424•5555. � <br /> � �, � � �t�'� �icE- l,�:r-�r�:: c�•-�o-acC� <,�llCrz..-r.../' �(07. � '�, � � <br /> ��� l/ C C�QE= � <br /> �7u.a-Y� � Co�u.�n,�'of �.o a Mefer , <br /> I � <br /> �_ � <br /> ' � O <br /> a <br /> , <br /> I -- �; u�:G:�.� Btii.t�n: <br /> '� � . � ACKNOWLE�GEMENTOFCONDITIONS I <br /> 1�� 0�� � The undersi�ned owner/applicant hereby agrees to hold and save harm� <br /> "' lesc Ihe C'ly ol Evereft Irom any and ali claims for damages, cosls, ii <br /> �- � � �i / / expenses, or causes of action Ihat may arise because ol installation � <br /> c � ' 'L �Q L= �//��/ and mainlenance ol Ihe improvement or other rightrof-way use hernto � <br /> �/ ���orr�� <br /> �� applied to and lurther a ees b remove same upon notice Irom iho <br /> Approved f nsisQclio� /— ate City anJ �place publ' roperty damaged Ihereby. <br /> � �� / ,;"� �� . � /Q_�.�./ , <br /> s <br /> FI LINSPEC',I � � 1� Date � <br /> Approved as Conslructed S' natur�oi AFPlican Date � <br /> WORK AU7IIORIZED BY THIS PEqMIT MUST BE STrRTED WITHIN � <br /> �� PUBLICWORKS�EPARTMENT 1B0 D4YS UF DATE PERMIT IS ISSUED AND THE�EAFT�R IS TO <br /> � ,�r� 3200 Ceder Slreel BE DIUGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> E•�erett,WA 98201 C�NCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone:259�8810 pqOJECT OVEfi�JO DAYS DU7ATION. � <br /> I <br />