Laserfiche WebLink
tin .: � %., . , : , :, ...�, ... .„ ".� _- <br /> m r m Date '- ---- <br /> �7 c,co c,��i . --- --- <br /> p � � AppliwUon For _ _ <br /> C �'+ <br /> � y " PUBLIC WORKS PERMIT Puo�¢Worhafee S _ <br /> Tolel Fea <br /> N � � <br /> y � �..i Lrssnooi �eeva�� S yn nC <br /> K n <br /> H x eai.�o�o�� s <br /> ° .�+ °w Print or Type O��;y <br /> N i-' <br /> GZ `� S,. ' y/ . . . <br /> o � � ��:rd� <� I)� r� F' 7 �-�7 kc�-, ����a.� � ��. Ft�r'�r+a ! t', 71�s 3� �y ..i <br /> � t�'1 n �Owner � Mailin9Address City Zip Phone <br /> H , C _ <br /> Z' M �I � ;\i L r l� (� , � � r I i <br /> y H � in v 1 r� . � f <br /> r H H � A�n�,���� MailingAdd�ess City Zip Phone <br /> J Vl <br /> nO N / -/-!.-. i '. <br /> � Cry � �0 c L< �^e'� r q �-./F I� p v� C � t (�G n /< . .s P C � ._ ., <br /> Z Drscnbe Pioposed Work 1 /r� / <br /> H O vNi ���.i•� S. �n/a �l IJ No� �O PkCecc� el�-.(nl ( O � K<� � v� __. <br /> /i /C � �F � — <br /> '— -- � <br /> Z3I7 �erili,� o • +I, vl �ee E � . ._;., � <br /> Fiaicct Address(il known) _ �' <br /> Auac;h tour 14!copies of plans br proposed wo�k� Draci lo scal��rnd note the lollowing as applic,d�i..�. �� <br /> • Properly L��es • Centerline of sVicel /^ <br /> • OutlinC and dimen5i0�5 01 all ewstm9;ind • Indicaie NOCh V� <br /> proposed structures on the lot • Show any proposed�.7�aUin9 ri:anqeti <br /> • Eaisting and proposed uUlities • Show measumme�ns M <br /> W <br /> DO NOT PJR�TE BELOW iHIS LW[ � <br /> i �e ncq^.11TCONpITIONS <br /> ' � ' 1.All calls lor inspeclion shall be made 24 hrs.in advance-phone 259•8810. ^ <br /> ��► 2 fdl work shall 6e pedormed in acwrdance wilh lhis permit and currenl City ol Leerett Desi9n and Consiruction ♦ <br /> Standards and Specifications. <br /> ' � 3.Call Localion Underg�ound Service 48 hrs.belore you dig.TOLL FREE NUMBER 1•800•424•5555. � <br /> I '�� <br /> � <br /> "`� 7• �t�c%;�. -y .>/.cti�/>c .l.•�7'�lG-.%� . , „-y �' . , . . ./ <br /> ( �,r <br /> Crnz..•i'i«r7�a,� Sf�...,�e,vr� �3�S� � i <br /> ... %'� ir` .-/�. � 1 <br /> ':/'. , ,. . ._ �-:� . . . . . <br /> �s Y/ <br /> '� � <br /> � �� � <br /> � �� � �p� AGKNOWLEDG[tAEMOFCONDITIONS <br /> � ."�N" Thc w�tlersi,n��d ownevapplicant hereby agrees to hold.��,,:s.r,��i'.,���n- <br /> -- Icss Ihe Gly o� Everetl Irom a�y and a�l claims lor d:��n:iy�.::,. �.os�r, <br /> � � � �� � �� expenses, or causes ol ecti0� �hat may aiise because ol ;nslallahon <br /> � �+ and mamtenance ol U�e improvement or other righbol-way use hc������� <br /> �l G L'7 �'�" I �7 9.� applied for and huther agrees m remove same upon notice hom u�,� <br /> ;,uproved Ior Constru�.�lpn � ��e Gly and to replace publiG ro erry damage�eby. <br /> `` ` — �. z <br /> �"'�- in- .�c . � l� ,.�—�f�� f3•y- / <br /> FINAL INSPECTION �a1e Dato <br /> „pn�o�ed as Construded �gna oi ApPlicant <br /> /Ii�_/ PUBLICWORKSDEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE STAFTED WlTlill�l <br /> � 180 DAYS OF DnTE PERMIT IS ISSUED AND THEREAFTER IS ill <br /> 3100CederStroet BE DILIGENTLY PUASUED TO COtdPLLTIOtd THIS PER�1�T 61AY OC <br /> ��:qrMl,WA9B207 CANCELLED BVTHE GITY UPONl.;:'� '����i��'�.�:� '�� ::'n';�'' ���J ���IS <br /> Pi cne�259-ealo Pq(1JEC7 OCFR°0 Df V'S DURAI lCr': <br />