Laserfiche WebLink
� <br /> , <br /> ,�- <br /> Date. -� PuGlic Worka permit• <br /> APptication For eiao oeo��• <br /> PUBLIC WORKS PERMIT PUEIi�WorksFae <br /> ,o�.�Fe, s — <br /> Less ADO�Fee PsiE S <br /> Frint or Type Only Bslance D�e s - <br /> �� <br /> _,_I��',q-�'�'r, �✓/�G' �� �� / � �,�:QL.� �r/�-,�'-� -�f�,�/,/ ,�r` �7G <br /> Owner Mailing Address Cily Lp Phone,��'� <br /> _�%r�� <br /> Applicant Mailing Address Ci�y Zip Phone <br /> z <br /> G�Or✓S'7%2[/�T it/E�cl C�,<iv c� /.Q C O�'�' c'l �. � <br /> Describe Pioposed Work � J � •�- F ���Q y <br /> �. <br /> c'� <br /> m <br /> — — - ! � 1 �� <br /> °roiec!Address(i!!;nown� — �.�/�— /.e4it/� iJ� _ � y= <br /> v <br /> m <br /> ��.;tach lour(4)copies ol plans for proposed work• Draw to scale and note the followiny as applicablc� <br /> � Properry Lines � m o <br /> � Centerline of sireet <br /> • Outline and dimensions of all existing and • Indicate Norih � o � <br /> proposed structures on the lot • Show any proposed grading changes --I z <br /> � Existing and proposed utilitics • Show measurements = "'� <br /> m <br /> �O N07 WRITE BELOW THIS LINE � 'c��. Z <br /> O r <br /> PERMIT CONDITIONS � � <br /> 1. All calls for inspection shall be made 24 hrs. in advanca-phone 259-881 5. � N <br /> K <br /> 2. All work shall be performed in accordance with this permit and current City of Everett Design and Conslruction ' o z <br /> Slandards and Sper.ifications. T y <br /> 3. Call Location Underground Service 48 hrs. before you dig.TOLL FREE NUMBER 1-800-424•5555. =m <br /> /�� 1 / Z m �-. <br /> �' �� �C� ��L�� o r <br /> ��{�G-G�-C�2. �-(/v' Zf'r C%Si J2- <br /> O �m <br /> _ N <br /> � ) �'J� � N <br /> C�7!.C�'..�Cl�-� /GC'.%t'� � C� r�2�G.Gt'��{� . Z � <br /> // <br /> C/ � �m <br /> � a <br /> ��� cw-1 .�z,�,C� ��� y (/� � <br /> ,�,L `v /�-. .. � " " ��r�d� �arQ n <br /> c�iLC.C��L Q�� �'�/I'�-�'�iE'C'' ��G'�..�ti%LU" ��''��`t2�4.C/ O --� <br /> z <br /> i ♦. � <br /> i��,/ �, s �. � <br /> Sf�„ ,..�. /��_�� z <br /> �i�.�1����-� y r y �9s� o <br /> � <br /> ACKNOWLEDGEMENT OF C DITI S m <br /> The undersigned cwner/applicanl hereby agrees to hold and save harm- <br /> less the Ciry of Evere;t I�om any �nd all claims for damages, costs, <br /> expenses, or causes of acfion that may arise because of installation <br /> and maintenance of the improvement or other right-of-way u5e hereto <br /> Approved lor Construc�ion pa�e �PP�ied icr and turther agrees lo remove same upon notice Irom Ihe <br /> City and lo replace public prope:ty damaged ihereby. <br /> FIN�\L IIVSPECiION Date <br /> Auproved as Conslructed Signature of Applicant Date <br /> overett PUBLIC WORKS DEPARTMENT WORK AUTHOR12ED BV THIS PERMIT MUST BE STARTED WITHIN <br /> � 3200 Cedar Street 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Evcrett, WA 98201 BE DIUGENTLY PURSUED TO COMPIETION. THIS PERAIIT MAY BE <br /> Fhone: 259�8815 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> ' PROJECT OVER 90 DAYS DURATION. <br /> i <br /> � <br />