Laserfiche WebLink
� � � . <br /> � <br /> �o m ; . ,. . / i � , , „,,,,�,. � �i- <br /> � y Date�—/�� ;��:�, I : �� -,,: � <br /> �� �iDo� ^ <br /> H � H . � AnPlication Por.� C^ - Z l -�� I ---'------------__. <br /> " f�t9BLIC W(�RKS PE�MIT `'��°'"w""``` <br /> o � o ,o�,���� 5- <br /> ry1 hl 'sl ' ' t uss�noi Fee PaJ S - <br /> N H '-� <br /> � :._i nC <br /> f�ai�:no��un S— C�-� <br /> � �' �" Prinl or Type Only ;� �� �� <br /> °z n o =, :., .,, <br /> , .,> �, <br /> ..� <br /> ¢ � �i . ,,. I' :'n/ 1)(� �� �% � �r-�u, ���V L�7"�-�J l�i i'l � y��`-.}-O i �5'�^ �'��'_ ) <br /> b H � �+ MaJing Ad�dre5e. w �.� � City 7ip --� Phone <br /> t� OwnAr m o • <br /> �..� L J O 1- L I <br /> y '� ri ii T r: � �� <br /> " S ��� � S�z Z��P � :� �, ,c�,,.�,�,� �,- �,�2-a� s 3? � �;_ <br /> � O V7 <br /> � m � -�APPlicani hlailint)�ddress City Z�(� Phonc <br /> O V1 � � �/ �J �J ! J�"�v J /� 7' J n'1 �� / �� ���'Y',� <br /> � <br /> pescribe Proposed Work _,� � � � y� � <br /> � ; <br /> _ � <br /> � <br /> Prolect Address lil knownl L�� 7� � � � � � �� � J� � � � <br /> '��g= C�'ccr�i D,t'. � <br /> qttach lour(n�copies ol plans lo�Z�Posed work� D�aw lo scale anA note Ihe lollowing as applicable: � <br /> • Property Lines • Centerline ol sireet <br /> • Outlin?and dimen5io�s ol all existing antl • Intlicale Nor�h <br /> p�oposed structures on ihe lot • Show any proposetl gratling chunges <br /> • ExisU�g.nd proposed utilities • Show measurements /� <br /> W <br /> j��y+ DO NOT WRITE BELOW THIS LINE O <br /> ,. PERMITCONDITIONS <br /> 1 � 1.All calls for inspection shall be made 24 hrs.in advance-phone 259•8810. � <br /> _ 2.All work shall he pedormed in accordance with this permit and current City of Everett Design and Construction <br /> ' �► Standards and Specilications. <br /> ��� 3.Call Lccation Untlere�rountl Service 48 hrs.before you dig.TOLL FREE NUMBER 1•800•424•5555. � <br /> �♦ / � ��� <br /> � <br /> I � /�i /.u/� Ll .�__ _ r'.JCr_CCG {YfLJ� ci _r� . .y� ;- � .. :i <br /> �� � 3�(/! / /` <br /> _� �F/L �Ccl� S?...�.CGn.Cf'' # CGI�-� �O�J� 4.�'i.c%..// � <br /> �_-��ss� .� �P SC:..(, �Q f�,�L'�-�� �!,i f� �o`c// �`'i r�. a.1- C'-�C"��� [',�'G.1' ... � _/ <br /> ..�� i.-,=-/.��.� r�=l�� � <br /> � �o. <br /> _� — <br /> � <br /> � ACKNOWL[DGCMENT OF CONDITIONS <br /> ;1��� The undersigned owneVapPliwnt hereby agrees to hold and save harm� <br /> less the Cily ol Everett Irom any and all claims lor damages, cocis. <br /> � eapenses, or causes ol action that may anse hecause ol installation <br /> I �(/%/ � i: �- antl maintenance ol Ihe improvemenl or olher right-ol-way use hereto <br /> �( �'/��7 ^:✓�' I ��/5�r apUlied lor and lurther a9rees lo remove Samc upon noiice Irom Ihe <br /> Approved lor on tr lion Oate Ciry and�o repl ce putihc proUerty tlamaged thereby. <br /> 4. �.c'`_��— y/G `o /v1 ��i�b. /�J� �J`��U((�� <br /> FINAL INSF'ECTION Dalc � f � �" DaI�� <br /> Approved as Consvucted Sig re ol ApPlican <br /> � K AUTHORIZ[D BY THIS PERIAIT MUST BE STARTED WITHIN <br /> eveiet� PUBLIGWORHSDEPARTMENT 180 DAYS OF DA7E PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200CeaarS�reet �3[ DILIGENTLY PURSUED TO COMPL[TION.THIS PERMIT MAV BE <br /> Evere4,WA 98201 C�NCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone.259�8810 PFIOJECT OVER 90 DAVS DURATION. <br />