Laserfiche WebLink
� <br />S C" '9 <br />Ch [+7 <br />a �3 <br />�D�fS <br />tY" � tA <br />y 5H <br />� H� <br />"{7 M "+C <br />yH <br />H <br />z <br />� F� � <br />O H�y <br />� [�j7 C <br />�� <br />r �-+ H <br />S `� <br />C1 C7 t/� <br />� � [s7 <br />HO� <br />Date�U��1 U <br />i <br />Applicalion For <br />�UBLIC WORKS PERMIT <br />Print or Type Oniy <br />__ I � <br />pwner <br />�yG' 1 fq�\ C b N C <br />Applicant <br />DesCribe PropoSed Work _ <br />AAdress <br />Ma�ling AOtlress <br />Cuy <br />r+ <br />Zip <br />n�ni��. w�... v.�mn . <br />eiy� n..�i • /%)�— <br />n„oi�,.won.ai.e S - <br />,�,.,� ��� <br />«,,.�o, ��� �„� s <br />r.u��.o��� 5 <br />Prolecl Adtlress lil known) �. � :,� .� C �� .� �� __ <br />Atlach four I4) copies ol plans lor propose�' work � Draw to scale antl note Ihe loilowin9 as appbcable. <br />• Property Lines • Centedme of street <br />• Outlme and dimensions ol all exisimc� antl • Indir.ate North <br />pwposed strudure5 on the lot • Show any propOsetl 9ratlinp chanc�cs <br />• E.isting anA n�onosed utlli�ies • Show measurements <br />�[LOW <br />PERMIT CONDITIONS <br />1. All calls br inspection shall be mode 24 hrs. in advance - phone 259•8810. <br />2. All work shall be pertormed in ac�ordance with �his permit and current City o1 Everett �esign and Consimction <br />Siandards and Specilicalions. <br />3. Call Location UnCcrground Service 48 hrs. before you dig. TOLL FREE NUM6ER 1-800•424-5555. <br />�-� , _ <br /><,, ,<,,_ <br />�� <br />.�-;� . <br />;-��-��� <br />ApProvetl lor Conslruclwn Date <br />I FINAL W::PECTION <br />ApproveA aa Co�siiucted <br />I rw•rrlt �U�LIC\VOHKSDEPARTMENT <br />3: 00 Cedar Slmel <br />[v.�eu.VJA 98201 <br />�I� Pnona:259�9810 <br />W <br />� <br />�w <br />_ f <br />Z <br />O <br />� <br />O <br />a <br />ACKNOWLEDG[MENi OF CONDITIONS <br />The �mderslgned owner/appbcanl herehy agiees to holtl antl save harm� <br />iess Ihe Gty o� Everelt Irom any antl all claims (or damages, cosls. <br />expenses, or causes ot achon ihat may arise because of mslallatlon <br />and m3intenance of ihe imp�ovemanl or other righPol-way use hereto <br />applieA br and Imthm ayrees to remove same upon nohcc Iwm the <br />City anA to replace pu6hc property damageA thereby. <br />Dele I Date I <br />S�9niture oi AnOI¢ant <br />WOFK AUTHGRI7ED BY TF'IS P[RMIT MUST BE STARTED WITHIN <br />1B0 JAYS OP DATE PERAIIT IS ISSUED AN� THEREAFTER IS TO <br />BE DILIGGNTLY PURSUEO TG COMPLETION. THIS PERMIT IdAV BE <br />C4NCELLflO BY THE GTV UPO�I ANV STOPPAGE Of 1NORK ON THIS <br />PROJECT O\ Ef, 90 DAYS DURATION. I <br />