Laserfiche WebLink
r — <br /> ��� //'�^ ` <br /> Date` "�-z" �'3 Pu�iiclYarkaPermit� __�!�'�L�— <br /> i <br /> ei�a.oaoi.• <br /> Application For <br /> PUBUC WORKS PERMIT PUOToteIF<a`e8 � �� <br /> r-- <br /> ��se nooi.Fee vma S_� <br /> Belence Due $ O <br /> Print or Type Onry <br /> NEr �J/4i � /C��✓ ��6 ��[��b ��c �'% 3 �fi4 �N1E ���J � u� �'v�'�i ^�� ��� r� r/,�JO �� ��ti77///4 <br /> Owner Mailing Address Ciry Zip Phone � ' I (� <br /> _� <br /> `� y 191C' !c S q, �(if�dC- SCI l —"/" <br /> Appliwnt Mailing Address City 2ip Phone <br /> (+ 3z��Z — c�331 <br /> DescribeProposedWork re��� F" �/ Qr�L�nd ��[ lLS ' <br /> W <br /> Proiect Address(ii known) ���� S/ � L�����LC/�� � <br /> Altacii .'uur(4)copies ol plans for proposed work� Draw lo scale and note the following as applicable: �I <br /> • Properry Lines • Centerline of street � <br /> • Outline and dimensions ol all existing and • Indicate North <br /> proposed stmctures on Ihe lot • Show any proposed Breding changes <br /> • Existing and proposed utilitie5 • Show measuremen�s M <br /> W <br /> DO NGT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 1. All calls for inspection shall be made 24 hrs. m advance� phone 259•881 5. � <br /> 2. A!I work shall be performed in accordance wilh this pennit and currenl Ciry ol Everett Design and Construction <br /> Standards and Specilications. <br /> 3. Call Location Underground Service 48 hrs.belore you dig.TOLL FREE NUMBER 1•800•424•5555. � <br /> i /� <br /> �/L G �.�//.�ilT/� �'EC �� T�'�-/i\ <br /> � ���,c cr/,JNT O <br /> �-s-,� <br /> CvJ'r� ,�- C;�y ��--_=�--�s ,;r ca,,,�i'•�— ✓,7� oL�, <br /> /�,q�'J° r <br /> � <br /> � <br /> a <br /> ACKNOWLEDGE�IENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees to hold and save harm- <br /> less lhe City of Everett irom any and all claims lor damages, costs, <br /> ��/ �j espenses, or causes ol action ihat may arise because of inslallation <br /> � � � and maintenance of the improvement or other righ4ohway use hereto <br /> �� apPlied tor and further agrees to remove same upon notice from ihe <br /> Ai ro ^Construc� � Date City and to replace public properry damaged Ihereby. <br /> /' � � � <br /> � ---� c <br /> - �a,�— �y���_ �'.�l<�!t '6�,v �7 —��-c�<3 <br /> RPIAL INSPECTION Signatur ol ApPlicant Date <br /> Approved as Cons�r �etl <br /> WORK UTHORIZED BY THIS PERMIT MUST BE STARTED WITHiN <br /> ��.����� PU�LIC WORKS DEPARTMENT 180 DAVS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200 Cedar Street BE DILIGENTLY PURSUED TO COMPLETION. THIS F'ERMIT MAY BE <br /> Everett.WA 98201 CANCELLED BY THE CITY UPON AIJY STOPPAGE OF WOFK ON THIS <br /> I Phone: 259-8015 pROJ[CT OV[R 90 DAYS DUFA710N <br />