Laserfiche WebLink
Date 3 �7 5''S- r�ni��wo,weae,m�i. ��� �--� <br /> Application For aic9 oeu�.• <br /> PUBLIC WQRK� PERMIT PuoTo�FeeFee a �G� <br /> LessA00� FcePa�tl $��— <br /> Balance Duc S�0 <br /> Print or Type Only <br /> ��� / ' ��� � v� r�f� �s��� � �5���� yS' <br /> � � � r � <br /> wner Mailing Address City Lp—�one <br /> � ,1�.�Sl — ^ <br /> qpp— licant � Mailing Address City ZiP Phone � <br /> --� <br /> hy�' n <br /> Describe Pro ased Work ,// IL� f' l — ���� n� 'v�'� ��� /✓'v r�' m <br /> P �.4-1 � .. <br /> fiC� L?r-�T F�C l.Gi✓�,5�'dr-'i�fJ�� Cu,p�lC <br /> ��S �o L � �, <br /> W .. � <br /> �, _ <br /> / 0 <br /> m <br /> Prolec�Address(il knOwn) /�`���'�� � ��� 'P�� � m o <br /> i <br /> --�c <br /> At�ach tour(4)copies of plans for pr000sed work- Draw to scale and note the lolluwing as applicable: �� o 'm <br /> • Properry Lines • Centerline of sireet /^ _ � <br /> • Outline and dimensions cl all exisling and • Indicate North V� m <br /> proposed structures on th=lot • Show any proposed grading changes � � <br /> ! Ezisling anA proposed utiG'ies • Show measurements � p � <br /> .r-� ._. <br /> DO NOT WRITE BGLO\N THIS LINE .-i tn <br /> PERMIT CONDITIONS O o � <br /> 1. All calis for inspection shail be ��ade 24 hrs. in advance- phone 259•881 5. � T n <br /> 2, All work shall be perlormed in actordance with ihis permit and current Ciry of Eeeretl Design and Construction 'i�^ <br /> x <br /> Siandards and Specilications. m "" <br /> 3. Call Location Unde�ground Service 4� his. before you dig.TOLL PREE NUMOER 1•800•424•5555. � p N <br /> o r <br /> c-�m <br /> cN <br /> � �,�.�y ,-y,�� �,�,-��:%�� y«�.�� � �� O � � <br /> ���t� � ,s ,-� �,��,J�T�.� Gyi��� �'�,�, � D <br /> H A <br /> � <br /> .�. �'i Ty �t-S N o T �c cu�jyf�.�hhc� r ic�i�� crr/��.� ♦j� n <br /> \r/ Z <br /> ;��= Gyfu�� .�'i.*�,�U, .Y-�t;— ,�'�-r-v�mE.�2f' ,�'-c/��vi/.p� O = <br /> /,w,T-�p_ � <br /> � � <br /> / Q+v :l � CcTd�7��j J,L' i.�'c�1lLrl��"C7 " <br /> f�' .. Gy/V � �c/7,�i�7 i ' �� � m <br /> �y y_,��- <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersic��ed owner/applicant hereby agrees to hold and save ham:- <br /> less the Cily of Everett Irom any and all claims for damages, costs. <br /> � J, eapenses, or cvuses ol achon that may arise because of installation <br /> ��� `3���— and mainlenance of Ihe improvement or other righFol�way use he�elo <br /> applied lor and luther a9rees to remove same upon notice Iron Ihe <br /> A roved� onsUdctip�. / �a�e City aod/tolreplacc public property damagetl thereby. <br /> -_� � � � � I 7� ��, <br /> .� -- �� i� '-� i"- - i�t`� �' <br /> FINAL INSPECTION Date � �� <br /> Approved as Cunstruded � Signat ol ApPlicant 1e <br /> i����i.�� PUBLIC WORKS DEPARTMENT �'�'ORK AUTHORIZED Y T . PE BE STARTED WITHIN <br /> O 3200 Cedar Sireel 1B0 DAYS OF DAT . - ISSUED AND THEREAFTER IS TO <br /> EverelC WA 98201 BE DILIGENTLY ED TO C0�9PLETION. THIS PERMIT MAV O[ <br /> Phone� 259�8815 CANCEL THE CITY UPON �NY STOPPAGE OF WORK ON THIS <br /> PR -CT OV[R 90 D4YS DURATION. <br />