Laserfiche WebLink
� 7�d �.,mr.�va so�ii��i ��� — ���1� '/ <br /> Date� � " �� �-� <br /> r <br /> uiao ocoi-• � ^�-- <br /> Application For <br /> PUBLlC WORKS PERMIT ''°'�°`°'°,"FOe — <br /> ,o�.,�«o s <br /> � � � TO POSTING_ Le55p�n��c�P�" 5�-- <br /> !�,- z S _v,� a,�.,�«o�� s n <br /> p �x Print or Type Only <br /> � Hy <br /> � �� �i 1 f• � I � ,� �: �c'� gx ?.2 (�� ' � 281.(:�3 �5 2_332 C> <br /> t�yC Q Owner Mailmi�Address City Zip Phone <br /> H� <br /> � NH %i . � n �71i — <br /> �,�� APPlicanl Mailin9 Address Ci�Y Zip Phom: <br /> �o ��' 1J �� 1=K <br /> Descrihe Proposed Wark <br /> � � g <br /> �V � <br /> zyy � � <br /> rHH <br /> gy �"� Prolect Address 1�1 known) _I �l I r r � <br /> dy - ` � - ' — <br /> �� r Atlach low(4)copies of plans for proposed work- Dmr��o scale and nole Ihe lollowing as applicahle: � <br /> �'� • Properly Lines • Cented�ne of stroel ♦^ <br /> y0 y • Oulline and dimens�ons ol all existing antl • Indicate Norih V� <br /> proposed s�ructures on�he lo� • Show nny proposed gmAing changes <br /> • Eaistinc� and proUosed utihties • Show measuremenis <br /> �'G <br /> , DO NOT WPIiE B[LOW TNIS LWE � O <br /> I PERMIT CONDITIONS UOOOZ601; <br /> � __ 1.All calls lor inspeclion shall be made 24 hrs.in advance-phone 259•8810. E�DG $382.CO � <br /> 2.All work shall be pedermed in accordance with this permit and current City ot Everett Design�¢�onsiruct�0.00 <br /> ��� Standards and Specilications. C'I 460.00 <br /> 3.Call Location Underground Service 48 hrs.belore you dig.TOLL FREE NUMBER i•800•4�,�5�5. gg,45 � <br /> E SFCH $4•� <br /> ' �� DRVW�' g''0.00 O <br /> i ��� 1400007101 <br /> WaTEn 9b50.00 � <br /> N000�8050 <br /> SEIJEF. A30.00 � <br /> �.� CHECf; 51184.95 <br /> a <br /> !�-� a <br /> ���, /� u -1CI<NOWLFDGk�Pd[N7 OP CONDITIONS <br /> ��� The undersi9ned owner/app�icanl hoieby a9iees lo hold nnd savC haim� <br /> less ihe City ot Everelt Irom any and ail claims lor damages, costs. <br /> expenses, or causes ot action ihal may arise 6ecause ot installa�ion <br /> ��/���� /J �1��1/�D and maintenance ol Ihe improvemenl or niher ric�h4of�way usc hereio <br /> T�� �» ��'� � applied lor and furiher a9iees to renove same up.;n nohcc irom Ihr <br /> lpproved I�stru��" � ���e � City and to eplace public property damaged thereUy. <br /> /•��7 l_� jD_ �7�%% � �"5�/a .,/ <br /> �INAL INSPECTION Date �� �,L�=` �Jt --.✓' � l — <br /> lpproved as Con.-,trucled Si, a re ol Applicanl �3�" <br /> N10 . AU7HORIZE� BY THIS PERIv.iT A4UST BE STARTED WITHIN <br /> everett PUBLICWORKSDEI ' T 1& DAYS OF DAiE PERMIT IS ISSVED AND THEfiEAFTER IS TO <br /> � 3200CetlarSireel B� (+'LIGCI:iLV PU�SUED TO COh1PLETION. THIS P[RId1T MAY BE <br /> Everett WA98201 CANCELLED BY?HE GTY UPON ANY STOPPAGF OF WORK ON TI'IS <br /> Phane:259�eB10 PqOJECT OVER 90 DAVS DUPATIOPL yt��' <br /> Il.^.� <br />