Laserfiche WebLink
�i . � <br /> �-G a�- as7 <br /> �fl�C__.� Puel¢Worws Parm�i. <br /> � � BiCB.DeGt • �/ �� <br /> Application Fer � —�T� <br /> PUBLIC N/ORKS PERMIT �ueTotalFeaFep s <br /> �ess aoo�Fea aa�a s <br /> ealance Due S ��00 <br /> Print or Type Only <br /> 33�-/�TS <br /> � o��, o �o��� ,�(�fLL �n J'� f=6w.�e P/Gt l/� .��;� <br /> � MaiHng Address City Zip hone <br /> Appli ent4 M�ilingAtldress City Zip Phone <br /> Describe Proposed Work ��/A-F6z_,��L��� <br /> W <br /> Prole��Address(il kmwn) �5��� U�`AN� � <br /> Attacl:four(4)copies ot plans for proposed worM- Draw to scale and note the lollowing as applicable: � <br /> • Property Lines • CeMedine of street � <br /> • Outline and dirrensons of all existing and • Indicate North i <br /> proposed siructures on ihe lot • Show any proposed gratling changes <br /> 1 Existin9 and proposed utilities • Show measurements /M <br /> W , <br /> DO NOT WRITE BELOW THIS LINE O '. <br /> PERMIT CONDITIONS � <br /> 1. All calis lor inspection shall be made 24 hrs. in ativance� phone 259•881 5. <br /> �. All work shall be performed in accordance wilh this permit and current Cily of Everett Design and Construction � � <br /> Standards end Specifications. I <br /> 3. Call Location Underground Service�18 hr�, petore you dig.TOLL FREE NUMBER 1-SOO•424•5555. � ! <br /> I <br /> !�, STQ.C�ri lJ,�i9iq/9GE' f3�E f�•r/O .�.!',9..r//�GC 1j�?GJf O � <br /> dl-.cii.v� i.siF �'o.�-�o�'EA ffOv.rE !✓9GtrT �'F.�.9�.✓ <br /> Of E�✓, � : <br /> N � <br /> O <br /> a <br /> ACKNOWLEDG[MENT OF CONDITIONS <br /> The undersigned ownedapplicant hereUy agrees to hold and save harm� <br /> �ess the City ot Everelt Irom any and all claims lor damages. cosis, <br /> � expenses, o�� causes ol ac�ion Ihat may arise Uecause ol inotalla�ion <br /> �-yY��j� _ So?7 8,6 and maintenance ol ihe improvement or other right-obwaY use hereto <br /> applled lor and turiher agrees to remove same upon nnticc irom Ihe <br /> Approved lor onsVuction , Date City and to replace public Property damaged thereby. <br /> ���� a-a6-tz �c�%l�� �-� <br /> FINAL INSPECTION Date <br /> Approved as Const�ucted Signature oi Applicant Date <br /> PUBLIC WORKS DE?ARTMENT WORK AUTHORIZED BY THIS PEHMIT MUST BE STARTED WITHIN <br /> everett 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200 Cedar Street 8E DILIGENTLY Pi1RSUED TO COMPLETION.THIS PERMIT MAV BE <br /> Everett,WA 98201 CANCELLED BY THE CITY UPON ANY 3TOPPAGE OF WORK ON'fHIS <br /> Phone: 259-8815 pROJECT OVER 9U DAYS DURATIO�. <br />