Laserfiche WebLink
,:.,�� <br /> , , <br /> . ; <br /> / <br /> � Y S� D � ��o���wo„sP„m„. 9o-z��s <br /> � <br /> DOte eiaq o�o� • <br /> AOPlica�ion For Uj <br /> pUg��C WORKS�ERMIT °"°"`w°„"°° s <br /> iolai fae <br /> � O Lasa Appl Fee Pa�n S =0 <br /> �{� � o g aa�,��e o�e s 33 <br /> E � <br /> � � Print or Type Only � M N� OOZ�.j22 -5�0 -Od 0-/8 -c➢3/ <br /> ;: �+ `w�' <br /> H�" � �- ''�� � � � �f�u�` �- .— w,�. � ��3 SS?�, <br /> �j �../Q �,�----� o �.: ia CiIY Zip Phone <br /> N �w�0 Mailing Atltlr�s �'�' <br /> � � <br /> R�� �' � g � � <br /> �(/�✓���0— Phone <br /> Mailing Address C�ty 7ip <br /> �� qpplicant � <br /> � d � ' � �/% �/z.�q� �r ,6.9� i <br /> Q(�Cy Describe ProPosed\Vork / <br /> �--'%/ i�(, a /u,r <br /> 09 O /n f�ij h Q �� <br /> r �� <br /> �y� AGovT /�U G y��� B�'� CO/17OLfTED �FFdG�' A/-�G/CATd� W <br /> N � <br /> °0 7�i7 E f/ea f�ier _ <br /> ~ Project AdGress lil known) <br /> �� , <br /> �r Attach four(4)coPies o�p�d�s�or pwPosed work� Draw lo scale a�d�ole�C�^�;°�Wine ol�n����a�le: � <br /> W • propertY Lines • Indlcale North <br /> GO • OWline and dimensions of all erisimg antl � Show any proposed qraAin9 changes <br /> � ProPoaed simctures on ihe lot • SYGw mcasuremeMs � <br /> • Exis�in9 a�d propose0 utilities <br /> DO NOT WRITE BELOW THIS LINE O <br /> 1 PeRMIT CONDITIGNS � <br /> C� 1,q11 calls for inspection shall be made 24 hrs in advence-phone 259�8g10. <br /> 2.A�I work s�all be pedormed in accorAance wl�h this permil and current Ciry of EvereU Desi9n and Consiruction <br /> Stendarde and Specilicalions. � <br /> ' 3.Call Location Underground Service 4B hrs.before you dig.TOLL FREE NUMBER 1•SCO•424•555 . <br /> � e,,,,f .Qi1�.l�' fu �za,a�a�.'l�d .� �6 i.Z��%� O <br /> � � `�, <br /> �1 �v.� �-�'�L`` ��' ����. � <br /> '� /� �—� ,� � d��h� � <br /> �� .7 �0�1tOvy qi.� S.rLO�i/1'i�".��rOry C1P"�'v' <br /> I ��' � o�v�t.��O � �,� � Pv6Lcu klo�/y /�n..�.t-a7`c�'y <br /> O <br /> � -- <br /> a <br /> � ACKNOWLEDGEMENT OF CONDITION� <br /> The undersi9neA ner/applicant hereby ag�ees lo hold and save harm� <br /> less Ihe Cdy o Ev retl Irom any and all claims lor damages, costs. <br /> ezpen5e5, or 2 I aClion ihal may arise bewuse o� in5ta!�a��0� <br /> ��s 9O and ma��ten e 1 th �mprovemenl or other righPof�way use e�e�o <br /> ' �. plied lor d f rlher rees to �emnve same upon otice fr m the <br /> Approved onstru�ion ���� DaIO C�y and lo ePl ce pu c pmpe�ry damaged thereby. _ <br /> �� '' .�i��� �5 J �� <br /> a e Dale <br /> FINA INSPECTION i naWre 1 plicant <br /> ApprovedasConstructed yy RK AUTHORIZED BY THIS PERMIT M'JST BE STARTE WITHIN <br /> � everett PUBLICWORKSDEPARTMFNT Y80 UAYS OF DATE PERMI7 IS ISSUED AND THEREAFTER IS TO <br /> O 3200 Cedar Sireet �BE DIIIGENTLY PUFSUED TO COMPLETION.THIS PERMIT MAY B[ <br /> Everett.WA 98201 CANCELLED BY THE GiV UPON AN1'STOPPAGE OF WORK ON THIS <br /> Phone:259�8810 PFOJECT OVER 90 DAYS DURATION. <br /> � <br />