Laserfiche WebLink
_ --- - ✓ <br /> Date F�:e�,�wo,��Pa,m��. �s� 3�3 <br /> Applia'�ion For eiaq oca�.+ ��� ��"��',L —_ <br /> PUBLIC VIiORK� PERMIT PubTcnlFeeFce S -- <br /> Less Anui ��e Paia 5 <br /> .�Cy��.� <br /> Bolance Ouo �u <br /> Print or Type Only <br /> {�/��(l�1fiN�> I�� ��1;.�'�c�SE� I � IU L �iL1!�'1f�'C.) �Z-'���( "7T� ���'�- tiC�i�l- <br /> Owner Mailing Address City Zip Phone <br /> l _. �L,.. . , E�.•��� = , -�^- <br /> ��C�N� l� ��d ��-�' l � ��C_ '�"� �-(V�l�:o �A�' r�G (�; ��' 'v' / A <br /> Applicant Mailinc�Address Giy Zip Fhone <br /> Descnbe Proposed Work _ ��� <br /> Prolect Address(il known) ( � � �� ��'�����j� — � <br /> � <br /> Attach four(4) copies ol plans for proposed work� Draw to scale and note the following as applicahle: � <br /> • Property Lines • Centerline of street /^ <br /> • Outline and dimensions of all existin9 and • Indicate North V� <br /> proposed structures on the lot • Show any proposed grading chz�iges <br /> • Existing and proposed utilities • Show measurements � <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 1.All calls For inspection shall be made 24 hrs.in advance-phone 259•8810. � <br /> 2.All work shall be pedormed in accordance with this permit and current City of Everett Design and Construction <br /> Standards and Specifications. <br /> 3.Call Location Und,rground Service 48 hrs.before you di�.TOLL FREE NUMBER 1•800•424-5555. � <br /> O <br /> � <br /> � <br /> O <br /> a <br /> I� ACKNOWLEDGEMENT OF CONDITIONS <br /> '+'`���;(�����+�s�.(bf�) The undersi9ned owner/applicanl hereby agrees to hold and save harm� <br /> — less Ihe City of Everett irom any and all claims for damages, costs. <br /> e ^ expenses. or causes of ac�ion that may arise because of insta!la[ion <br /> � (/ {�/I ���� .�.) -���� and mai n e of tl.e improvemen� or other right�ol-way use hereto <br /> �i����-t-l-� �'� applied or nd urther agrees lo remove same upon nntice trom the <br /> Approved lor Construction /, Date Cily an f t epia �e publlc property damaped thereby. <br /> / � � //-/U-1 O <br /> � � 1 � <br /> AL INSPECTION Date <br /> Approved as ConsVucled _ 1 Applicant Date <br /> R AUT RIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> everet[ PUBLIC WORKS DEPARTMENT 1 g0 YS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200CedarStreet BE DIL GENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Everetl,WA 99207 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone:259-8810 PROJECT OVER 90 DAYS DURATION. <br />