Laserfiche WebLink
�+^ r/� � �f �j�� <br /> Date1�(�L/ / f ` PuGIiCWorhaPermu• _ <br /> c <br /> � ApplicationFor �� emg.ueo�.+ <br /> PUBLIC WORKS RERMIT 7u01icWnikSFea 0� � <br /> Talol Fee $Q� <br /> Los9 ApO��Fae PaiE $— <br /> Ealance�uB $ ^�� <br /> Print or Type Only <br /> � <br /> n►��i��� ��� pr� �,2x �.�,� ��l�t� �g� s as9-�, <br /> Owner Mailing Address City Zip Phone <br /> ��r'� <br /> Applicant Mail�ng Address City Zip Phone <br /> Describe Proposed Work �A � C 7�� <br /> W <br /> ProJect Address(if knowo) � ��— �O/11M�1/�L. � <br /> Attach tour(4)copies of plan,for proposed work• Draw to sca�e and note lhe following as applicable: � <br /> • Property Lines . • Centerline of street � <br /> • Outline and dimensions of ail existing and • Indicate North <br /> proposed structures on the lot • Show any proposed qrading changes <br /> • Ezistinc� and proposed utilities • Show measurements M <br /> W <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 1. All calls for i-ispection shall be inade 24 hrs in�.dvance-phone 259•881 5. � <br /> 2. Ail work shell be performed in accordancr.with this permit �nd current City ol Everett Design a�d Construction <br /> Standards and Specilications <br /> 3. Call Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1•800•424•5555. � <br /> �/S! INSTA�CATin� of� F�E' Hf,o-Panr, ,Bf/ N/A%�2 L��r�T O <br /> ��,c' riiE Fi.c'E l�E.oT, /S/ rs'c C�Uil�r Q, <br /> / <br /> �/S �EED B L�l�OE .S-R•.� oF f�'PO."E.eT� `O�P � <br /> ALCEfi �E'iG�f'T-of- 6rJA� ���' WioE.✓ni..✓!s .,A�o.ri� <br /> j�,�r I.vEs.- Sir� C�' f�!'O�'�i:ry � <br /> lo. G�AOE �" Cs.E'A�/r'L A���y AccE,� A�o.✓� f�.✓r/�E• O <br /> a <br /> ACKNOWI.EDGEMENT OF CONDITIONS <br /> The undersig�ed owner/applicant hereby agrees to hold and save harm• <br /> less the City of E��erett from any and all claims for damages, ccsts, <br /> expenses, or causes oi action that may arise because oi installetion <br /> 6 and maintenance of the improvement or other right-oi-way �se hereto <br /> � � applied br and further agrees to remove same upon notice from the <br /> A ved lor po ru �a� Ciry and to replace public property damaged thereby. <br /> d����f��c:���J— �—.7��!� <br /> FINAL INSPE TIO Date <br /> Approved as Constructed �l,�neture of pli a t D te <br /> � WORK AUTHORIZED BY THIS PERMIT MUST BE STAR?ED WITHIN <br /> evereY PUBLIC WORKS DEPARTMENT I 180 DAYS OF DATE P�RMIT IS ISSUED AND THEFEAFTER IS TO <br /> `� � 3200 Cedar Street I BE DILIGENTLY PURSUED TO COMPLETION.THIS PERMIT MAY BE <br /> Everett,�YA 98207 CANCELLED BY THE CITY UPON ANY S70PPAGE OF WORK ON THIS <br /> \ Phone: 259-0875 PROJECT OVER 90 DAYS DURATION. <br />