Laserfiche WebLink
� i z '�'� <br />�Y <br />� 4�� - <br />z� � <br />yf+ i F <br />p <br />� = �: �. • <br />Dat?._( �/� �� <br />Applicatioc For <br />PUBLIr `.ild'OR�CS PERMIT <br />Print or Type Only <br />��3- a3..-c c� 1 y <br />Mailing Address <br />Describe Proposed Work � CcJ S� /e <br />Project Address (if known) <br />Pu�lic Worka Po�mii � '� �//� <br />emo. Doo� x s�� J� <br />Pu01ic N'orka Fee $ <br />Totel Fae <br />Less AppL Fee Paitl S <br />�alanceDue $ �7 �•��� <br />Zip <br />!ip rnone <br />Attach four (4) copies ol �lans for proGosed work - Draw to scale and note the following as applicable: <br />• Prupr,rty Lines • Centerline of street <br />• OuVire and dimensions of all axisting and t Indicate North <br />proposed strucWrea on the ict • Show any proposed grading r.hange= <br />• 6:ietin9 and proposed utilitieu • Show measuram=nt:: <br />PERMI f CONDITIONS <br />t. r.11 calls tor inspection shall be made 2a hrs. in advam.e - phone 259-881 �. <br />2. All work shall be per(ormed in accordance with ihis permit and current City of Evnrett Design and Cons�ruction <br />Standards and Specifications <br />�. Call Location Undergreund Service 48 hrs. before you dig. TOLL FREE NUMBE!-: 1-800-424-5555. <br />� T��S .d�t�d OTi/E,e Q�G.4�Y/G r��.dT�'izioL S' ih�/S7' <br />,8� Hd:/L.:� :i%� " ' <br />,r CONs��uG7 .4 S.�.s�.aGT �izivEwd� �om Sr,eEE'r <br />TO .cic-;�r- o�—����/ �/.vc'. <br />C' <br />J <br />Approved for ConsiNction / �ua�e <br />����I I-�—i 3-Pf <br />FINAL INSPECTION Date <br />Approved as Constructed <br />everett PUBLIC WORKS DEPARTMENT <br />� 3200 Cedar Street <br />Everett, WA 38201 <br />Phone: 259-8815 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />W <br />� <br />� <br />N <br />'■^ <br />V+ <br />� <br />a <br />The undersigned owner/applicant hereby egrees to hold and save harm- <br />less the City of Everett irom any and all claims for damages, cosis, <br />expenses, or causes of action that may arise because of installa�ion <br />and maintenance of the improvement or other right-ohway use hereto <br />applied for an ur h r agrees to remove same upon notic� from the <br />City and to r lac lic pro 7ty damaged thereby. <br />� zy �h � <br />Sic�nature Ap ant Date <br />WORK AUTHORIZED BY THIS PERPAIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY FURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJ[CT OVER 90 DAYS DURATION. <br />� <br />H <br />n <br />m <br />H H <br />H 'TJ <br />H �� <br />g <br />O � <br />C� <br />H <br />�z <br />�� <br />ryi F, <br />K � <br />O� <br />�r <br />� <br />� <br />� <br />. � <br />� <br />� <br />� <br />� <br />H <br />n <br />C�1 <br />