Laserfiche WebLink
i <br /> � <br /> Date�B'Q ��,��,<<vo,�sPa,m�. �'�— Z S_ <br /> Applicatien For ��nq Dept � _��ts�]_ _ <br /> . / , / <br /> PUBLIC WORKS PERMIT P��;o,WF�eF�� S _._ <br /> less Am+� Fnr paN S <br /> Print or Type Only B'�.,°,:'.°°° s <<�� _ <br /> -J�zviG�-111t�r (e>O'3 C31� „{�, �r F ve�pfi�- ��L i�S - 5 S 7G <br /> Owner Maihng Atltl ess� Ciry Lp Phone <br /> �-�oLLa-as�. �� �ln�" sF �—�Qi t1`' i 6'�@� 33 7�yGS�/ <br /> Applicant Maihng Adtlress City Zip Phone <br /> Dtscribe Proposed Work �Gt) �riJl��j(_ `OT ��� a�(�,��� �f�V Pr��7�_/�,1�,(i�j�_ <br /> / — <br /> Prolect Address lii known) � 7�3 .A�� — ��4 i,�JiG �/� � <br /> �•-7 � . <br /> Attach four(4)copies ol plans for proposed work� Draw to scale and note Ihe lollowing as applicable: � <br /> • Property Lines • Centedine al streel � � <br /> • Outlinr and dimensions of all existing and • Indicate Norih <br /> proposed st�uctures on ihe bt • Show any proposed grading changes <br /> • Existing and proposed utilities • Show measuremenis � <br /> DO NOT WR�TE BELOW THIS LINE <br /> PERMIT CONDITIONS O <br /> 1.All calls for insp>ction shall be made 24 hrs.in advsnce•phone 259•881 O. � <br /> 2.AI!work ahal�be peAormed in accordance with this permit and curcent City of Everett Design and Construction <br /> Stendards and Specifications. <br /> 3.Call Lceation Underground Service 4B hrs.betore you dig.TOLL FREE NUMBER 1•800-424•5555. � � <br /> J (//J�l�i..� .�lii�l�_ .5�-.�r..�L,�:-- .� (!� / �ii��.:� l�.li - O <br /> . / <br /> � <br /> � <br /> O <br /> a <br /> A\Li ACKNOWLEDGEMENT OF CONDITIONS <br /> ic�•E1. <br /> / VC/ The undersigned owner/applicanl hr,reby agrees to hold and save harm� <br /> less the Giry ol Everett Irom any and all claims for damages, cosis. <br /> expenses, or causes ol adlon that may arise because o� irtstallalion <br /> �- � � �� / / z• y ,) and maintenance ol ihe improvement or other nght-ol-way use hereto <br /> � ���`` r»� ��' � applied lor and lurther agrees to remove same upon noLce irom the <br /> Approved for Constructio Date City and to�eplace public prope�ty damaged ihereby. <br /> // <br /> � �/ ��'� � . J <br /> FINALINSPECTION Date ��-C ,V ��/y� 2�—�G(� <br /> Approved as Consiruded ign7ure ol hcant � Date <br /> ever�tl PUBLIC WORKS DEPARTMENT WORK AUT ORIZED BY THIS PERMIT MUST �E STARTED WITHIN <br /> � 3200CedarSlreet 180 DAYS OF DATE PERMIT IS ISSUED AND THEFEAFTER IS TO <br /> Everett,WA 98201 BE DILIGENTLY PURSUED TO COMPL�TION.THIS PEfiM1T Mh� BE <br /> Phone:259�8810 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAVS DURATION. <br />