Laserfiche WebLink
� �A18�.:�� •� -� . . auoiic worka Perm:�� p�/ <br /> i APPIiCeIIOnFor BIEp.DePt+_4_.[_ 3��; <br /> PUBL9C: `4MORKS PERM�T vueTo�aFaeFne ,; <br /> Less ApOt Fee Paio S <br /> Batence Oua S <br /> Print or Type Only — <br /> QS � p��L�c-�F�<��'�., <br /> Owner '-' �— Mailing Address City Zip Phone <br /> `I @--.��.rC'X /�A pC��61{},�, ���� �.'�aJ�c'.C_Q�r oi l5� — / C�� U-- <br /> Ap icant Mailing Address City Zi� Phone <br /> Desc,ibe Proposed Work ��- � a �`-`"����-. <br /> � <br /> W <br /> Project Address(if known) � � � <br /> Attach four(4�copies of plans for proposed work- Draw to scale and note the fo�lowing as applicable: � <br /> • Property Lines • Centerline of street , � <br /> • Outline end dimensions of all existing and • Indicate North <br /> pioposed structures on the lot • Show any pioposed grading chani�es <br /> • Existing and proposed utilities • Show measuremenls � <br /> DO NOT WRITE BELOW THIS LINE O <br /> PeRld1T CONGITIONS <br /> 1. All calls lor inapection shall be made 24 hrs. in advance- phone 259•881 5. � <br /> 2. All work shall Ce performed in accordance wilh this permit and current City of Everett C esign and Consiruction <br /> Standerds and Specificationa <br /> 3. Call Location Underground Service 48 hrs. before you dig.TOLL FREE NUMBER 1•800•424•5555. � � <br /> C~. <br /> �,,a�k r <br /> O n <br /> �b n.����` � �e5u�xf <br /> �e�.�� ' � <br /> y �. <br /> /�"�� � cn _ <br /> �a6e� O � <br /> /'7),�/� G <br /> �'• 3/�,/�� a � � <br /> � <br /> � � <br /> � � <br /> �p � <br /> ACKNON'_cDGEMENTOFCONDITIONS Cy F� <br /> The�ndersigned ownedapplicaN hereby agrees lo hold and save harm- H _ <br /> less the City of Everett irom any and all claims tor damages, costs, � c� <br /> expenses, or causes o: action that may arise because ol installation � <br /> and m�intenance of the improvement or other right-of-way use hereto ,.�.� : <br /> — applied tor and lurther agrees to remove same upon notice Irom the a '- <br /> Approved lor Construction Date City and to replace p❑blic property damaged therehy. � - <br /> ry . . <br /> FINAL INSPECTION Date 'c-,�." r � <br /> Approved as Conslructed Signature oi Applicant Date � �. <br /> everett PUBLIC WORKS DEPARTMENT WORK AUTHORIZED BY THIS PERMI f MUST EE STARTED WiTHI� { � <br /> � 1B0 C.YS OF DATE PERM1IIT IS ISSUED AND THEREAFTtR IS T�' . <br /> 3200 Cedar S�reet BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MA'/ B� <br /> Everelt,WA 98201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON l'Ni� <br /> Phone: 259•8815 r%ROJECT OVER 90 DAYS DURATION. <br /> � <br />