Laserfiche WebLink
� tr <br /> � <br /> � i- r' '�1 <br /> �� Date���� ;� '. �a�m��wo,x.a i � � - <br /> � Applicatiov For o�ec oep� • � <br /> q PUBLIC WORH:S PERMIT PuUTotaIF�eFetl $ — <br /> M'1�� Less Aopl Fee PaiO S <br /> ����(� Bawn.e Doe S I, <br /> Q�� Print or Type Only <br /> 91� <br /> �_Q �-� ,V�b�r��Q� �1��� Pn ►��� �y-�q ��.a�- q�� � ��aibi <br /> 0 N �lTOwner Mailing Address City Zip Phone <br /> Q1.��� �� <br /> ��„� Applicant Mailing Atldress City Zip Phone <br /> � /��/� <br /> �p7���1 Describe Proposed Work ���` ° / �� <br /> �Q�00 <br /> 6� � <br /> .. ._ .,�.� � <br /> Pmjecl Address(if known) <br /> Attach lour(4)copies of plans lor proposed work- Draw lo scale and note the following as applicable: � <br /> • Fropeny!.ines • Cenlerline ol slreet ♦A <br /> • Outline and tlimensions ol all existing and • Indicate Nor:h V� <br /> proposed struc�ures on the bt • Show any proposetl grading changes <br /> • Existing and proposed utilities • Show measuremenls /�A <br /> W � <br /> � , DO NOT WRITE BELOW THIS LINE O ' <br /> i <br /> � � PERMITCONDITIONS <br /> � ��� 1,pll cnlls lor inspection shall 6e mutle 24 hrs.in advance�phone 259-8810. � '. <br /> 2,A l l w o r k s h a l l b e p e d o r m e d i n a c c o r d a n c e w i t h i h i s p e r m i t a n d wrrent Cil y of Everett Desi9n and Conslrudion . <br /> ' j ; Standardsand5pecilications. ', <br /> 1 3.Call Location Underground Service 48 hrs.belore you dig.TOLL FREE NUMBER 1•800•424•5555. � <br /> __ <br /> � '''' �� ��'�`� � ' <br /> . i __ �,� ��_ZZ- �s � . <br /> � <br /> � -- <br /> � O <br /> o. <br /> � , <br /> __ <br /> I ACKNOWL[DGEMENT OF CONDITIONS <br /> The unAersi�netl owner/applicanl hereby i�rees to hold and save harm- <br /> '�� — less the City ot Everet� trom any ;nd .,II claims lor dama9es, cosis. <br /> __� expenses, or causes ol action Ihat may 3rise because ol installation <br /> and maintenance ol the Improvemenl or other nght-ol-way use hereto <br /> - applied lor and lurther ac�rees lo remove same upon nolice trom the <br /> Approved lor Construction Date City and to replace puUlic property damaged ihereby. <br /> FINAL INSPECTION Date <br /> pppwved as Consiructed Signature ol Applicant Date <br /> WORK AUTHORIZED [3Y THIS PERMIT MUST BE STARTED WITHIN <br /> ��i�i�� PUBLICWORKSDEPARTMENT 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200CedarStreet BE DILIGENTLY PUFSUED TO COMPLETION. THIS PEFMIT MAY BE �I <br /> Everett,WA 99201 CANCELLED BY 7HE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phonc:259�OB10 PROJECT OVER 90 DA\S DURATION. ! <br /> I <br /> I <br /> � <br /> � <br />