Laserfiche WebLink
% <br /> Date �' �� g� 8� -Z90 <br /> . w Pubhc Wods Parmn s <br /> Application For e�eo.000�.• _ <br /> PUBLIC WORKS PERMiT PUCIicWorksFea <br /> Totel Fee s <br /> L¢55 Appl,F!B YtliC S <br /> Print or Type Only ea�a��a o�e S 2D� <br /> 3s"j - J J �',> <br /> MarK D• MQJ'�L( 3d � I � �.1�,r Eve,-v61 �v �., �S'a- -,3a�� <br /> Owner Mailing Atldress City Zip Phone <br /> ,fo-+...` < h-� d(�r�. Y��f \.� � /f J <br /> Applicanl Mniling Address City Zip Phone <br /> DescribeProposedWork ��-�C P'r���� (oa �e_(..r�� ,,� �-J- 1 O..�C.c.r � ,�o� c`�p 1 <br /> Y <br /> TNSrAGC C�' /Up �G LE/ i�Af//�.C�/. <br /> W <br /> Project Address(if known) 'r0' �� � <br /> Aftach lour(4)copies ol plans for proposed work- Draw to scale and note ihe following as appliccble: � <br /> • Property Lines • Centerline ot sireet � <br /> • Outline and dimensions of a�l existing and • Indicate North <br /> proposed structures on the lot • Show any proposed grading changes <br /> • Existing and proposed utilities • Show measuremenis � <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> t. All calls for inspection shall be made 24 hrs. in advance• phone 259•881 5. � <br /> 2. All work shall be pertormed in accordance with this permit and current City of Everett Design and Construction <br /> Standards and Specitica�ions. <br /> 3. Call Location Underground Service 48 hrs. belore you dig.TOLL FREE NUMBER 1•800•424•5555. � <br /> �O�E,C .C7oie/� i�E'2 Hi��Cf/e�� csi�'c�i C� O <br /> C�j'rCiY/�i9�T�'J OIiTGC=T Pi�E _ � " /�/� <br /> Pf�i���G SF'cT.o .c� - � " CC•9SS .a � fJsr7�/�c.7' V♦ <br /> o l�E,e ��. c,��f,s�Fo Sc%eF.9��.✓!,- . O <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees to hold and save harm- <br /> less ihe Ci�y ol Everett Irom any and all claims For damages, costs. <br /> expenses, or causes of action that may arise because of installation <br /> ��=�`�7���-=� / zo 8,� and maintenance of �he improvement or other righFol�waY use hereto <br /> �P applied tor ard Wriher agrees to remove same upon notice Oom �he <br /> Approved lor Constivction� ate City and to replace public property damaged ihereby. <br /> �1� �-.z j -K �l'��---�1�'—�SZ_ 6 �-��- o �8 f� <br /> FI INSPECTION Date � <br /> Approved as Constructed Signature ol Applicant Date <br /> everett PUBLIC WORKS DEPARTMENi H'ORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> � 3200 Cedar St�eet 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everett WA 98201 � BE DILIGENTLY PURSUED TO COMPLETION.THIS PERMIT MAY BE <br /> Phone: 259-8815 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PRCIJECT OVER 90 DAYS DURATION. <br />