Laserfiche WebLink
��� , 7�i ; <br /> ,�yyy DateS-1llG � r��nerwo,wsv.. �. 1 -_-�•X�j'n <br /> H Z� oinn o�o�., �� � -/-1 b_ <br /> ApPlication Fo� <br /> PUBLIC WORKS PERMIT �'°°��°w°,�"�° 5 <br /> ��Q iotni ire <br /> M � lvisAppl Fce Pau1 S_�_ <br /> yy TO POSTING 1-�3 �,�,���.��" 5 a�>� _ <br /> � �O' Print or Type Only <br /> H <br /> ��8 � r�r�n �1�»���1 Po �X :3�Ja I �� 3�7 90c� <br /> w� o �.--� <br /> � Owner Maiung Address Cay Zip Phone <br /> C" y C�,.,�n <br /> H Z1�I/�' - — - <br /> gy H 6 Applicant Maihnq Address CJy ZiP Phone <br /> n�N 1/1`(�'rT1 � c� T x,/ <br /> �. Descn6e Proposed lVork _�I , `! J `� � J�� �� '✓�����' ` <br /> �Ht�i� <br /> HOV� - <br /> W <br /> Prolec�Address lil known) � `� �' � <br /> Altach IOur�41 cOpi¢s o) PI0n5 for prOpoSPd work� Draw lo stalC anA note Ihe 1011owing 0s apPlicable: � . <br /> • Property Lines • Cente�Gne ol streel ♦^ . <br /> • Outl�ne and dimension5 0l all existing antl • Indicate North V� '. <br /> proposed sirucWres o�Ihe lot • Show any proposed grading changes <br /> • Existmg and proposed utilities • Show measurements � <br /> DO N01 WRITE BEIOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 1.All calls for inspeclion shall be made 24 hrs.in advance-phone 259•88�0. � <br /> '�' 2.All work shall be pertormed in accortlance with this permit and current City ol Everelt Design and Conslruction <br /> Standards and Specifications. <br /> ' ' 3.Call Location Underground Service 48 hrs.bnfore you dig.TOLL FHEE NUMBER'I•800•424•5555. � i <br /> w /� <br /> �—� /��'t�' •�taC'-,�c'c.,ti-...<C>:,�u-cf�� �7�«...:T'/� G " �1«�.�r.(c 7 � <br /> . ' <br /> ��' /.r�.��/�� .S�-«�r� ��a,�._ �Z; -��, �«C��I.� , <br /> lr � <br /> 11 (J� <br /> �_i � <br /> � a <br /> - <br /> 'i ACKNOWLEDGEMENTOFCONDITIONS <br /> / <br /> � The undersi9ned owner/applicant hereby agrees lo holtl and save harm� <br /> less Ihe Cdy o� Everett Irom a�y and all claim� br ozmages. costs i <br /> I� ��I ezpenses. or causes o� oction Ihat m.�y arise Gecause ol installation <br /> � $ �j L 7 c� 7 and mamtenance of Ihe impro�ement or otker righ�-obway use hereio <br /> 1 ' /�Z/L' �<</� �! �'� (�y appl�ed for and �urther aqrees L remo��e same upon notice Irom the <br /> � Approved�o on ��uction ��e CM1y antl lo rpplace pubhc property damaged there6y. <br /> l' �G'� fi�/^ � 5 D„� ._�. , d� � . ���5 �9 <br /> FINAL N PECTION <br /> Approved as Consiructed u 13 ure o Applir t Date <br /> WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITNIN <br /> everett PUBLIGWORKSDEPARTMENT 1B0 DAVS OF DATE PERA717 IS ISSUED AND THEREAFTER IS TO <br /> � 3200CedarStreet BE DILIGENTLY PURSUED TO COMPLETION.THIS PERMIT MAY BE <br /> Everen,WA 98201 CANCELLED BY THE CITV UPON ANY STOPPAGE OF WORK ON THIS <br /> :�hone:259�8810 PROJECT OVER 90 DAYS DURATION. <br />