Laserfiche WebLink
DetB1� • 7 � a�eu�wo�k..•o�mn. � - 3S _ . <br /> , Application€or �_ eiey.o�o�.• <br /> PUBLIC WORI�S PEf�IQAIT � <br /> PuEbc Worke Fee <br /> Totel Feo S <br /> lT. <br /> �' LessAppl Fee Peid S <br /> Print or Type Only L� � n r �: ;; Balance0ue S—c�C�VD <br /> "' v = �.� 002-.��Ly 0/Sf'3/ <br /> �:, ._i o � � :. ,., <br /> F� CI PJ <br /> �'� <br /> �: ,,. '.';�203 <br /> P,oy A. :: liillian �i. Soltner 1 Ed� mo ' � !� rett. l;a ' �G619L6- ',�39;. <br /> Owner Meiling tldrQes Citp���� ' Zip phone <br /> � rn cu: � u-� ' ` <br /> vi o t,� �� - � ' <br /> --� o x i,� •- c , y I <br /> r;oy b. So).tner 171& 'r:c�emoor =� a?-ie, %�erett:. .1�1r "h`L' 3 s mA �c �hov <br /> Applicant Mailirg Address Ciry Zip Phone <br /> Describe Proposed Wcrk F]'ODOSP.O �OCkery 3' hi €�h x lE0� lo�? Wi t'1 1 ' tVi ria �=' r�^n ' n <br /> S'tOrie i OT' C�T`2.1ri2�� h h�t7d rn k op�k�r tn ha hiii l j- 1� 1'rnm i n i A ri�n n _ <br /> existin� sidewalk on ri�ht or way. <br /> W <br /> ProjectAddresspfknown) 1 1�s i�d emoor -. n . ' I�,. *: �: � <br /> Attach lour(4) copies ol plans lor proposed work• Draw to scale and note the following as applicable: � <br /> • Propehy Lines • Centerline ot street � <br /> • Outline and dimensions ot ell existir�g and • Indicate North <br /> proposed structures on the Iot • Show any proposed grading changes <br /> • Ezisting and proposed utiiities • Show measurements � <br /> DO NOT WRITE BELO'N THIS LINE O <br /> PERMITCONDITIONS <br /> 7.All calls for inspectbn shall be mede 24 hrs.in advance-phone 259•8810. � <br /> . • 2.All work shall be peAormed in accordance with this permit and current City of Everett Design and Construction <br /> Standards and Specifications. � <br /> 3.Call Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBFR 1•800�424•5555. � <br /> f, C'ar�,�lGic�tf nnat,le� �.� � ��„.d�� �32�f- �o� <�.z`(`'ru�Gd�� O <br /> � �"Lcl�+-qQ� 7�'7cc.�-7� �174c�-ftcrv ^�L�CPI^�, <br /> � II <br /> �NITIAL INSPECTION � � <br /> KIRK BROOKS O <br /> DATE — //- 7 -� 5� � <br /> � ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees to hold and save harm• <br /> less the City of Everett Irom any and all claims lor damages, costs, <br /> expenses, or causes ot action that may arise because of instaliation <br /> �•G ,Q L� /��5�yL and maintenance of the improvement or other right-obway use heretu <br /> ���"����� applieA br and further agrees to remove same upon notice fwm the <br /> Approved lor Co stryc/Iion �^ Date City and Ie replace public Groper;y dama9ed thereby. <br /> C_ �� � / <br /> ��-�� �- ��- s.� <br /> FINAL INSAECTION� Date <br /> Approved as Constructed Signature ol ApplicaN Date <br /> ��� PUBLICWORKSDEPARTMENT WORK AUTHORIZED BY HIS PERMIT MUST BE STARTED WITHIN <br /> 3200CedarStreet 180 DAYS OF DATE PERMIT IS ISSUED AN� THEREAFTER IS TO <br /> Everett,WA98201 BE DILIGENTLY PURSU�D TO COMPLETION. THIS PERMIT MAY BE <br /> Phone�259•8870 CANCELI.ED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT UVER 90 DAYS DURATION. <br />