Laserfiche WebLink
� <br /> � <br /> Date J2 1y�'7 <br /> Pupbc WorkS Permil• <br /> ApDlicallon For e�.+a oeo�.• <br /> PUBLIC WORlCS PERMIT PwbcWork�Fee <br /> Toteifee s <br /> Lesa ApPI.Fee paia Z <br /> Print or Type Only ea����e��� f <br /> I <br /> �l_'��r�awr e f(itc�; J,� l °>n �,,. I(2fo._7 FvP�- 9R�n� �j£�_7'/�—`� <br /> Owner � MaiHng Address ��� "�—� <br /> Y Zip Phone <br /> 11�.�uZ/n n� ('rt,n ��- 7"�-r-1ya.�ISB E VP/ t�+� s� 9�Lri� I�5'q '_ cl/9'/ <br /> Appiitant MaJinp Address — <br /> ���Y 7iP Phone <br /> Describe ProposeA Work �(��Mn�P' QO�,I �1J((?��/YL <br /> Project Addresa(if knpwnl — �Z– Z_7—�7 � <br /> Attech four(4)copies of plans lor proposed work- Draw tu scale and note Ihe following as applicable: � <br /> • Prope�ty Lines � <br /> • Centedine ol street � <br /> • Outline and Aimensions of all existing antl • Indicate North <br /> proposed structures on the lot • Show any proposetl grading changes <br /> • Existing and proposed utilities • Show measuremenis <br /> DO NOT WRITE BEIOW TMIS LINE � <br /> PE�,�h�T CONDITIONS O <br /> 1.All calle for Inspectlon shall be made 24 hre.in advance•phone 259-8810. <br /> 2.All work shell be performed in accordence with this permit end current City of Everett Design and Construction ' <br /> StenOarCe and Specifications. <br /> 3.Call Lacat(on Underground Service 4B hrs.beforo you d�d.TOLL FREE NUMBER 1•800�424•rJ555. <br /> �/ G'�6�� �� �v�r,� ��,m;�, ,� Z <br /> �� r-f � o <br /> � <br /> � <br /> O <br /> a <br /> ACl;NOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees to hold and save harm• <br /> less ihe City of Fverett from any and all claims for damages, costs, <br /> ezpense5, Or Causes ol aCtion that may arise because ol inslallation <br /> and maintenance ol �he improvement or other right-of-way use hereto <br /> Approvr.d tor Consiruction Date �3pPlied for and further agrees to remove same upon notice Irom the <br /> City and�o replace public property damaged thereby. <br /> FINAL INSPECTION Date <br /> Approved as Const�ucted Signature ol Applicant <br /> Date <br /> everett PUBLIC WORKS DEPARTMENT WORK AUTHORI2ED BV THIS PtRM1T MUST BE STARTED WITHIN <br /> � 3200CederStreet 780 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTEF IS TO <br /> Everet�WA 98201 BE DILIGENTLY PURSUED TO COMPLETION. TIiIS PERMIT MAY BE <br /> Phone:259-8810 CANCELLED BV THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAYS DURATION. <br />