Laserfiche WebLink
� �[a ro <br />10 �7 G <br />C y <br />� � S <br />H <br />n <br />O m O <br />� (~!1 H <br />� �'i � <br />"`°R <br />�, • <br />t' H � <br />H H <br />N <br />M <br />O tn <br />� � [r9 <br />O N <br />� ( � <br />oa��� I�•�2 <br />qppiication Por <br />PUBLIC WORKS PERMIT <br />PrintorTypeOnlyTO POS�ING— �� 2 <br />G�'f'G f� �) <br />Owner <br />Mailing <br />�V <br />Y <br />v„��.�wo,.ino,m�i. _���� <br />o�ay oco�.. . - <br />Puoi¢Wo�ksFee 5 <br />Toiai Fea <br />LessT001 FCe FaN 5 _. � — <br />9aia�ccoue S �jl'— — <br />C'nL-.�t.'� %C>/ i_=; � <br />�da�ting Address City Zip Phone <br />Applicant <br />Q.E�1.,�E 2 �XI�I. G�� <br />DescKribeI ,P�o�poysed Work <br />V I1� �� 1� <br />Project Address Id known; <br />Attach four 141 copies of plans for proposed work � Draw to scale and note the loliowing as applicable: <br />• Pruperty LineS • Centerline ot stree( <br />• Outline and dimensions ol all ezisting and • Indicate North <br />proUosed siructures on Ihe lot • Show any propOsed g�ading chanc�eS <br />• Existing antl propcsed utilities • Show measuremt�nts <br />PE' .iTCON0ITIONS <br />1. All calls lor inspection shall be made 24 hrs. in advance - phone 259•8810. <br />2. Atl work shall be pedormed in accordance with this permil and wrrent City of Everett Design and Construction <br />Stand. rds and Specilications. <br />3. Call Location Underground Service 48 hrs. betore you dig. TOLL FREE NUMBER 1-800•424•5555. <br />T, \�fl.'. L['d�tl=�- .L� !J< [�'�i._ /1��. �/.�'�z. .�. r�/ �"/5—�.i<:- ( `�,�,yr', m�.'G.., <br />�` ! � .-i� �� C< %,� c�%<<! . , C% /`� i<. / , /" - <1, ' J`_ <br />,�/1 , -,,.. / <br />.�- <br />FINAL INSPECTION <br />Approvetl a� Construc�ed <br />�PUBUCWORKSDEPARTMENT <br />� 3'00 Cedar Slreet <br />Evcrc�t. WA 98201 <br />Phor.e�.259�8810 <br />c <br />-/z-`�`� <br />o„� <br />W <br />� <br />0 <br />N <br />Z <br />O <br />♦�^ <br />Vi <br />O <br />a <br />A�KNOWLEDGEMENT OF CONDITIONS <br />The unaeis�gne - ownedapplicant hereby a9�ees to hold and save hann� <br />less Ihe City of Everetl irom a�y and nll claims lor Aamages, costs, <br />expenses. or causes N action Ihat may arise because o� insiallation <br />and mamtenance ol Ihe improvement or other righ4of�way use herelo <br />applied for and luriher ac�rees to iem ve 5ame upon notice Irom ihr.� <br />Cily and to r la ubhc proper�Y �9 thereby. <br />�C, � � , I.S� y� <br />Signalure o Applicant Date <br />WORK AUTIiORIZ[D BY THIS PERh11T MUST BE ST�RTED WITIiIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND Th1EREAFTER IS 70 <br />BE DILIG[NTLY PURSUED TO COMPL[TION. THIS PERMIT M11AY BG <br />GINCELL[D DY TH[ CITY UPON ANV STOPPAGE OF WOHK ON THIS <br />PROJ[CT OVER 90 D:��'S DURATIOP7. <br />