Laserfiche WebLink
Date�� PUEIit Work6 Permit• ��-�-�I�/y�-��y'— <br /> emp.Deo��+ �� ' � ' ' <br /> Application For �--T_ <br /> PUBLIC WORKS PERMIT PuOToIaIFeaFee s <br /> Lecs Aoo�Fae Pa�U � _ <br /> ealanca Due s 33� �5 <br /> ?ii�; �rType Only <br /> C ��-����, � �U�..�� o/ �� C�dS%- S�S�/ <br /> Owner Mailin A dre City �C Zip Phone <br /> �� -- � �M-»_`� .R`�:���� � �xt� oC�..,�, �. �3-/Ss.1' <br /> Applicant Mailing Address City 2ip Phone Z <br /> 0 <br /> `� dr�o ��,Q� � <br /> Describe Proposed Work ���� � �`^ �' -`"—' - � <br /> m <br /> � —i T <br /> .. --1 <br /> N 2 <br /> � . m <br /> Project Address(if known) c o <br /> m o <br /> Attach four(4)copies of plans for proposed work- Draw to scale and note the loll�wing as applicable: � �� <br /> • Property Lines • Centerline of sVeet � o m <br /> • Outline and dimensions oi all existing and • Indicate North <br /> proposed structures on the lot • Show any proposed grading changes = '� <br /> m <br /> • Existing and proposed utilities • Show measurements � � z <br /> DO NOT WRITE BELOW THIS LItJE r 2 <br /> PEHMITCONDITIONS O � N <br /> � <br /> 1. All calls for inspection shall be made 24 hrs. in advance• phone 259-881 5. � T <br /> O q <br /> 2. All work shall be pertormed in accordance with this permit and current Cily of Everett Design and Construction � <br /> Standards and Specifications. ""� ^� <br /> 3. Call Location Underground Service 4B hrs.betore you dig.TOLL FREE NUMBER 1•800•424•5555. � _ <br /> m N <br /> i <br /> -)! Iit�ST/,GL 11 S /'v/OE S�lJEcrJdL+C i�1N0 �'E/�N.E' O <br /> �1'/_'C,�EN CU,C'.8 GUJ PG G/�/C <i✓� /"�Z onlTd CvE � N <br /> ,aE,e c.�y sr�,�,na,eo r� 306 Z � <br /> � �n <br /> ,�l,� P ✓E A./�',6 BCTcJEE�t/ i!/Ec�l C�!/i�.v�%�/Gr z <br /> A,�/,D S/�i i T.�/ ST. w/Tis' a� � A S�l/.d G%� � � <br /> x <br /> n <br /> z <br /> Gj . �,crav/O E/ L/./�_ Co��E.✓e�/7 F� O = <br /> .$!Y/iTf/ l �GL�Gr/G.4 L , <.eC-C.G'iUEI� y/3d/�� � N <br /> Z <br /> 0 <br /> -i <br /> � <br /> m <br /> ACKNOW LEDGEMENT OF CONDITIONS <br /> The undersigned owner/apolicant hereby agrees to hold and save harm- <br /> less the City ol Everet�. Irom any and all claims lor Aamages, cosis, <br /> �// - -- ezpenses, or causes of adion that may arise because et installation <br /> � -/ --� � � J ^;���� _./.5 and maintenance ol the improvemenl or other right-of�way use hereto <br /> ) � �� � _"�� - applied lor and further aorees to remove same upon notice lrom Ihe <br /> Approved f r Cons�ruction ' � Date City snd J�place pu lic op rty damaged �hereby. <br /> /� � � / <br /> �!�- � 3-�.f' , � � - <br /> HL SPECiION Date � <br /> Approved as Constructed Signatu e o Applicant Dat� <br /> everett PUBLIC WORKS DEPARTMENT WOf,K AUTHORIZED BY THIS PERMIT MUST BF STARTED WITHIN <br /> 180 DAYS OF DATF_ PERMIT IS ISSUED AND TH[REAFTER IS TO <br /> � 3200 Cedar Street BE DILIGENTLY PURSUED TO CUMPLETION. THIS PERMIT MAY BE <br /> Everett,WA 98207 CANCC-LLED BY THE CITY UPON A.NY STOPPAGE OF WORK UN TIiIS <br /> Fhone: 259-8875 PROJECT OVER 90 DAYS DURATION. <br />