Laserfiche WebLink
� B8-yG8 <br /> � ���Q Publm Woeks Permll• <br /> DateJ1.�1�� �� nZ� <br /> eiae.oec • � ��_ <br /> Application For _ <br /> PUEiLIC WORKS PERMIT PubTotaFceFee S <br /> Less Aoo�`oe Peid S �j <br /> Balunce0uo S 4000 <br /> Print or Type Only <br /> ,�n � ��� � 1�L��i' ►�l�' YY�UI , q�7D la�-�-3 <br /> � �� Ciry Lp Phone <br /> Owner Ma�NoS Address <br /> � , Nailing Address City Zip Phone <br /> ppJr,a��'. <br /> Describe Proposed Work <br /> c(�'Z. LflT ��1 �ll� IJ1� CSI�'F-`rF� <br /> W <br /> - Proiect Address(if knovm) 2Z 3 - P.�oc,Fs ,Dr. . � <br /> �� <br /> Attach four(4)copies ot plans tor proposed work• Draw to scale and note the following as applicable: � <br /> • Property Lines • Centerline of street <br /> • Outline and dimensions of all existing and • Indicate North <br /> proposed structures on the lot • Show any proposed grading changes <br /> ' • Existing and proposed utilities • Show measurements M <br /> W <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMITCONDITIONS � , <br /> 1.All calls for inspection shall be mede 24 hrs.in advance•phone 259�881 O. <br /> 2,All work shall be performed in accordance with this permit and current City of Everetl Design and Construction <br /> � Standards and Specifications. � <br /> 3.Ca�l Location Underground Service 48 hrs,before you dig.TOLL FREE NUMBER 1-800�424•5555. <br /> Q �.cJ �2�v �Tnncof�'n.' .� �i�'��¢euevr��c��/ � . <br /> •y,�� /��ue �`.a 6� �,�fe , r��-, rn.-� /u �o��' � <br /> ,� �et � �� ��a,�r� S�c�� ��� Ge�'a� o� � <br /> �,�! /�t,L[,..g�y�( S-�Zcva� �..t'Ln� .G�.� L-c�2��- O <br /> A �� <br /> a <br /> /1 ACKNOWLEDGEMENT OF CONDITIONS <br /> /Ne, The undersigned owner/appli^ant hereby agrees to hold and save harm- <br /> ��`� less the City ol Everett Irom any and all claims �or damages, costs. <br /> / expenses, or causes of action that may arise because of installation <br /> ��� /2/ �a' and mainten nce of the improvement or other right-of-waY use herelo <br /> applied lor and lurther agrees to remove same upon notice trom Ihe <br /> .4pproved for Construc �o Date �{�y� replace pubhc p pe ty damaged thereby. <br /> 8 l�' � / . ��! �Ct2JV �7/ 0 6 <br /> FINAL INSPECTION �e ate <br /> ature ot lic t <br /> Approved as Constructed <br /> WOFlK AUT RIZED BY THIS PERMIT MUST BE STARTED WI <br /> everett PUBLICWORKSDEPARTMENT 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200CedarStreel BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAV BE <br /> Fverett.WA 98201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF`NORK ON THIS <br /> Phone:259•8810 PROJECT OVER 90 DAYS DURATION. <br />