Laserfiche WebLink
->, .�� ,�,��,���:,,»,.,,��,�my.,. � 8fl - 3> <br /> Datei�L u� � <br /> Giea ocn� • —'✓-���--- <br /> Application For _______. <br /> PUBLIC WORKS PE13MiT �'������cNbdsPca S _ <br /> �OIi11 FRC <br /> lre�ApplPouPaWs �.__—�--- <br /> palance�ua S <br /> Print or Type Only <br /> � //��n ` !V / ��/ � � �i �i��.l� 9��3 ����-<.�7�3 <br /> l ! /� � J� I' 1 ,� �i 'L l 7�t1 � � ._— ' Phone <br /> Ovmer <br /> MaNnc�Address Cdy �P <br /> �L�!�J Y1� Mailing Address C�IY ZiP Phone <br /> - Applicant <br /> Duscnbe Pronosed Work <br /> Vll�/a ) �_I�Y� __(�J-�--� u�lll l-�`'� <br /> - W <br /> Proiect Address I�i known) —! �'3� ! �/c(�_�� -- — H <br /> � <br /> qltar,h lour 141�opies of plans lor proposed work- D�aw to sr.aie and note the followiny as appliwble-. � <br /> • Piopeity Lines • Centerline ol struet <br /> • Indicate North <br /> • Oull.ne and dimensions ol all exislin9 anA � S���w 2ny p�oposed 9�adin9 r.hanges <br /> proposed structures on Ihe�ot � ghow measurements /� <br /> • Exisfin� and proPosed ulihties W <br /> DO NOT WRITE BELOW THIS LINI_ O <br /> NERMIT CONDITIONS � <br /> 1.All calls tor inspection shall be made 24 hrs.in advance-phone 259•8810. <br /> 2.All work shall be performed in acCordance wilh ihis permit and current Cily of Everelt Design nnd Constructicn <br /> StanG� �ds and Specifications. � <br /> 3.Caii Location Undergwund Service aA hrs.bebre you dip.TOLL FREE NUMBER 1•800•424•5555. <br /> O <br /> � <br /> N <br /> O <br /> a <br /> i�CKNOWLEDGEMENT OF CONDITIONS <br /> �^� — 7ti„�.inde;;�pned owneVapplican�heieby agrees to hold antl save harm� <br /> �a� — less the Cdy ol Everett Irom any and all claims br damac�es, costs. <br /> eapenses, or causes ol aclion Ihat may arise because ol inst.11ation <br /> / and mainlenance of Ihe improvement or olhe� rlghhof�way use hereto <br /> - �f��� �'�'�b+' . U� g aPPGed lor and Wriher agrees to remove same uPon nolice Irom the <br /> Apprwed lor Cons� �on <br /> City ano to replacu p p�oPerty damaged thereby. <br /> — �"j���' C-/- �r-f �-���-�e <br /> FINAL INSPECTION Datc Date <br /> Sipnaturc ol Appliwn <br /> Approved as Constru�fed y�ORK PUTHORIZED BY YHIS PERNIT L�,UST BF STARTED I�iTHIN <br /> evereU PUBLICWORKSDEPARTMENT 180 Dl:YS OF UATE P[RMIT IS ISSUED AND THEREAFTEF IS TO <br /> � 3200 Cedar Sireet BE DILIGflNTIY PURSUED TO C0�1PLETION. TiiIS PERMIT MAV BE <br /> Everet:.�VA 98201 CANC[LLflD k3Y THE CITY UPON ANV STOPPAGE OF WORK ON THIS <br /> Phmre.259�BB10 PROJ[CT OVER 90 UAYS DURATION. <br />