Laserfiche WebLink
r � <br /> � <br /> Date��6.3 P�,o,,�v�o,k�Pe,m:. <br /> Application Por eia9 oEo��• ���-�� s� — <br /> I`�UBLIC '• ORSL� P��MI� PueTotalFae�ee S- <br /> ' Less AOG�Fee PaIC $ ' <br /> Balance Uue $ <br /> Print or Type Only <br /> • / )Pi2 � U�c.��lt� /J� R ND�f �clek'e � aZ�`�o2-�j.37� <br /> Own Mailing pddress Cit/ Zip Phone <br /> �tlCi c �dY.'.3' /�ot7�,C' �.Pii�t�c� t--✓ri:�E� � ���` "��Dd' <br /> Applic Mailing Address City Zip Phone <br /> c� i / , I <br /> Describe Proposed Work r� � �� �"��•� <br /> �--�� , � C W I <br /> Project Address(il kno�vn) � - � f � � '� <br /> Attach four(4)copies of plans for proposeA work• Draw to scale and note the following as apPiicable: �� <br /> • Properry:ines • Centerline oi street � I, <br /> • Outlin�and dimensions of atl existing and • Indicate North <br /> proposud structures on ihe lo� ' Show any proU�-ed grad�ng changea <br /> • E��istinq and proposed ulilities • Show measuremer!s w/� <br /> �.,��� W <br /> DO NOT WRITE BEL.OW THIS LINE O <br /> PERMIT CONDITIONS <br /> 1. All calls for inspection shall be made 24 hrs. in ndvance- phone 259-881 5. � I <br /> 2. All work shall be pertormed in accordance with this permit and curreM City ot Everett Design and Construdion <br /> Standards and Specifications. <br /> 3. Call Loca�ion Uadergroupnd�Service 48,hrs. betore you dig.TOLL fREE NUMBEa[I-800-424•5555. � ', <br /> 0� �Y �� (�� ��, �v T� UD�i � <br /> J�� v � G✓ <br /> r � � � ' �P� V'�1 ��' �� �f G I�G�f� �� , �` � C � <br /> ��`� yL�� �'� � � ,� , � �� c� ��GF� � ,1� � a,�� � �q, <br /> �U �" �a �� �',�G . ��� �S1� � � � j �' � �� � � � � � ! <br /> �i � �/ �` �� ,� �� ��° � g�' G o�� Q <br /> � � 4 � <br /> �G ,�� �` ,�� �- ' �a . ;� �� � ��' �� ��;�� a <br /> v � �,o� �P � ��� � � b � � <br /> �� � �k � c �;� i �o� ; ��, �, 7�, �� <br /> � 1 D �/) I� � I ACKNOWLEUGEMENT OF CONDITIONS <br /> _— ___ / C/ __ The undersigned owqer/applican(Fierehy agrees!o hold and save harm� <br /> —���7'� — less tiie Ciry M EJe•ett from any ahd all :laims for damages, costs, <br /> expenses, or caus�s o; adion that-may arise because ol installation <br /> and maintenanCQ ef tl�e improvemEN or other ri�hbohway use hereto <br /> aFP�ied for an1 forther agreeslo.femove same upon no�ice irom ihe <br /> Approved lor Construction ���� City and to re0�oce publ�c�properly damaced ihereby. .. <br /> FINAL INSPECTION ���e -� , � I - <br /> Approved as Constructed Si�r.a�ure o1 Applicant Dale <br /> PUBIIC WORKS DEPARTMENT 1VORK AUTHORIZED'BY.THIS PERMIT MUST BE STARTED WiTHIM <br /> everell 180 DAYS OF DATB.PERMIT IS IS�UE� .4ND THER_AFTEF S TO <br /> � 3200 Cedar Streel BE DILIGENTLY PURSUED�TO COMFLETION. THIS PERMI7 IdAY 9E <br /> L-verett WA 98201 CANCELLED BY THE CITY UPON AN'f STOPPAGE OF WORK ON THIS <br /> � - _ Phonc: 259�8815 I <br /> PROJECT OV[R 90 DAYS DURATION. <br /> � <br />