Laserfiche WebLink
Date t_at_op , ,'/� <br /> PUEI¢Worke Pe.mit� <br /> Applicr,'.ion For eiaa o�a�.. 92/3 526 <br /> PUBUC WORKS PERMIT PubiicWorweFee <br /> - Totel Fee = <br /> �.�� Llta ADpI.fee Paid f <br /> Print or Type Onl�, TO POSTIN6 - i� - �s �e.�.��,o�e s /./ST_ <br /> � "; <br /> Providence��os�� <br /> . ital 916 Pacific Ave <br /> Owner , ,, Everett 2 <br /> �; MailingAddress Ci�Y — 12 <br /> -• i,; Zip Phone <br /> Botesch, N h 'S7 Hall 4206 Hoyt Ave Everett 98203 258-0868 Jeff Moore 6 Andy Hall <br /> Applicant Mailing Address City Zi <br /> P Phone <br /> Describe Proposed Work addi[lon 6 al ra Son <br /> Proje.ct Address�if known� 9l6 Pacific Ave � <br /> Attach four(4)copies of plans for proposed work- Draw to scale and note the following as applicable: � <br /> • Property Lines • Centerline of street — <br /> • Out�ine and dimensions of all existing and • Indicafe North � <br /> proposEd st�uctu�Es on the IOt • Show an <br /> .. � Existing and proposed utilities Y P�oposed grading changes <br /> • Show measurements <br /> DO NOT WRITE BE�OW THIS LINE � <br /> PERMIT CONDITIONS O <br /> t.All calis tor inspection shell be made 2a hrs.in advance•phone 259-8810. <br /> 2.All work shall be peAormed in eccordance with this permit end current City of Everett Design ar�d Construction ' <br /> StanAerde end Specificetiona. <br /> 3.Call Locatlon Underground Service a8 hrs.belore you dig.TOLL FREE NUMBER 1 <br /> -800�4245555. <br /> s! L-:r,s�,;, .�«�e-� �i4���•a .�, /k ,;�a._�/.,.��/'. � <br /> 4/y ` >>�,. �t �_.. ��c<<a� <br /> ��GGk. ��7 Cv( ' OZ. bl�...-/1.�..�! � <br /> � �� � � �ChG �/✓ �i_iit�/ l]Qn..-:� ('� 4-n��C'� � <br /> r c�; Y.•'.�� <br /> ?—�/—y2 fi., �c•,:-uz3` �,G�:r C✓->/'r.� � <br /> �• /E'r ��' �i^nF�%c L�.o� incc ,- � <br /> i �/��' c',s�'.- <br /> s��J�� � „ �c� � � „ �1' d,-;�;�,.�y ,»�,y �� a <br /> �� y -r„ - <br /> . i /� � i(��S/i"f'�l/i �1:S�r.[ 1iChJ� /n �d� �-Tc'.-r <br /> ACKMOWLEDGEMEN7OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees to hold and save harni� <br /> less ihe City of Everett from any and all claims for tlamages, cosis. <br /> � -" expensa:., or causes oi aclion ihat may arise because of instal�ation <br /> �z - a �/ �Z and maintenance oi ihe improvement or other righFof-way use hereto <br /> A proved for P siruction pa�e apP�ied lor and luriher agrees to remove same upon notice hom the <br /> � City and eplace ic property damaged thereby. <br /> r-r-sr <br /> FINAL INSPECTION Date ��z <br /> Approved as Constructed ;�ig� ot App cant r <br /> Date <br /> � PUBLIC WORKS DEPARTMENT Wc..7 AUTHORIZED 8V THIS PERMIT MUST BE STAFTED WIiHIN <br /> 3200CederSireet 180 DAVS UF DATE PEFMIT IS ISSUED AND THEREAFTER IS TO <br /> Everett,WA 98201 BE DILIGEtJTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Phone:259�8B7o CANCELLED BY 7HE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAYS DURATION. <br />