Laserfiche WebLink
� � <br /> , �; <br /> � <br /> Date---/�.�1� c�o�.<wa,�.n., �%- `f.2 = <br /> �. <br /> Applicalion For emc om�.• �—_1� <br /> PUBLIC WORKS PERMIT P°°°°w°,�°�°° — <br /> ioirlFee 5 <br /> ��� Le3�1001 Gwe PaiO S . <br /> Print or T pe Onl 2 e,���«o�. s nN /�fiin� <br /> Q�x Y y TO PQSTING_ �- 4-5 � �_�,3 <br /> c.J H <br /> 9 H fn <br /> H �� �f�',�P`T�kD 15x�n r�rr��c� i � �ti �� l���-� 9���a <br /> � n Owner � MadmgAdtlress City Lp hone <br /> H� <br /> � H� �;��- I�y.3 I <br /> V1 H <br /> qpplicant hlaihng Address City Z�p Phone <br /> H <br /> z / 1 Jl <br /> o �a I �l��l <br /> Oescnbe Proposed Work <br /> ��g �(PX <br /> yH� <br /> t' H y �7 � <br /> y Proiect Address(if known) /��/ A r� c. n - � ' �o� L �/� � <br /> N � i � <br /> c] C y <br /> � C� Aliach lour(4�COpies ol P�anS lor propo5etl�'�o�k• Draw Io Scale and noie Ihe follOwmg as applicable: — <br /> ti� • Centedme ol street �� <br /> • Properry Lines r,� <br /> y[A • Ou�line and dimensions ol all existing�nd • Indicate North r/ <br /> y 0 V) prOPoSCtl Slruclure5 on Ihe IOt • Show any prOposed gratling[h2nge5 <br /> • ExiSUng 0ntl propo5eo Wilitie5 • ShOw mea5uremen�s M <br /> W <br /> 00 NOT WRITE BC'_OW THIS LINE O <br /> PcRMITCON0ITIONS <br /> t.All calls for inspection shall be made 24 hrs.in ativance•phone 259-8810. � <br /> 2.All work�hall be peAormetl in accordance wrth this permil and current Cily ol Everett Design and Constmc:ion <br /> � � Standards and Specilications. <br /> �� 3.Call Location Underg�ound Service 4B hrs.before you dig.TOLL FREE NUMBER 1•800•424•5555. � <br /> '� � T f-��liNl� ICJ� "�' .Qlr �+/u% )7J,2/JC�� �i.l�Q�L`��c'�L'Y�• //3-3 9 O <br /> �� i� <br /> w ' /� r <br /> � /-C'�-CI'ly ,L'CY � a��•"`-f� Qy 2 ��Zc�tvnt�., �y � /C <br /> G.GY-3J )fJ / oZ ' CE� .4�i � <br /> �. e� � � (/ (/v J -i <br /> �1 ,a e'.a�ifmE'Y' �*�,'� �f �� C'�u e�-,�e./_�2 r^..G�a //� <br /> V♦ <br /> �q�i a <br /> S E I <br /> ACKNOWLE�GEMENT OF CONDITIONS <br /> ,� The undersigned owner/aGPlicant hereby agrees to holtl and save harm- <br /> �' � less Ihe City of Everett Irom any antl all claims lor damages. costs, <br /> I / ezpen5e5, or C�u5e5 0� aGiion thal may arise beCause of in5tallation <br /> f /�/J-� f n antl maintenance ot lhe improvement or other right-ol�way use hereto <br /> qqq ��•"`� v�� �/ `��! applietl lor and �urther agrees to remove Same Upon notiCe Irom Ih2 <br /> . �• Approvetl lor nsimchon Date City and to replace public prooerty damaged Ihzreby. <br /> C %�����G����� /���i� <br /> FINAL INSPECTION ���� Date <br /> ppprove�a5 Conslructetl Signature ut Applicant ���e <br /> evcrrlt PUBLICl90RKSDEPARTMENT �v�RK dUTHORIZED BY THIS PESAIIT MUST BE STAqT�J WITHIN <br /> O 3200CetlarStreet 190 DAVS OF DATE PERtdIT i_ ISSUED AND THEREAFTER IS 70 . <br /> Everett.WA 98201 BE DILIGENTLI' PURSUED �O COh1PLETION. THIS PERAtIT MAY 6E <br /> Phcne:259�8Bt�i CANCELL[D BV THE CI7V UFpN ANV STOPPAGc OF WORK ON THIS <br /> PFOJECT Ob'ER 90 DAVS DURATION. <br /> —__ i <br />