Laserfiche WebLink
-�-� -u�� �„�,�..w�,,,��.,� 3`/_ <br /> Date � ��_ <br /> Ohfq Oepl • <br /> Applicntion For ____. <br /> PUBLIC WORKS PERMIT '"°T��`aF^^Ffe s <br /> �exf PO�I �cr Pn¢I 5_�_� <br /> Oa�ancr Dva ��-- <br /> Print or Type Only <br /> '/ -���-�17�3 <br /> ���ra�Sf- I��Y��� I� ��ic1�1 `i Y�'�f�` 8�3 ,. � <br /> Owner <br /> Madmg AdAress C ty Zip Phone <br /> -` � Maihnp Adtlress Gdy Zip Phone <br /> qpplicanl <br /> Descr�be Proposed tNoik <br /> ��?���J �� 2 � T__�__� " �< < �2 i � — <br /> _ � <br /> Prolect Address(N known) 25�� � ���WG'��ST �iL�E — � <br /> � <br /> Attach tow P�I copies ol p�ans lor proposed work- Draw to scale and note lhe lollowing as appliw6le: � <br /> • Property Lmes • Centerline o� street <br /> • Out6ne and d��mensions ol all ex�sting nnd • Indicate Ncrtl <br /> preposed structures on!he lot • Show any proposed gradn�g changes <br /> • Existiny and proposed utililies • Sho•.v measurements M <br /> W <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS � <br /> 1.All calls lor inspection shall be made 24 hrs.in advance-phone 259•8810. <br /> 2.All work shall be pedcrmed m accordanCe with�his permit and currenl City ol Everetl Desi�n and Consiruc�ion <br /> Slanderds and Speci!ica�ions. � <br /> 3.Call L�cation UrAerc3round Service 48 hrs.before you dig.TOLL FREE NUMBER 1•800-424•5555. <br /> `�, /� G.risTi,✓�r I�,C'iv�WA/ �v�!'3 CuT /s .daT To � <br /> ,�qe= lCs�<' �02 Ts/� Acc�ss To iN.Es P.��T� <br /> Th:rr� iT �s ru � .i'�mnvEo � ,P6oc.q�Eo /NiT,/ H <br /> FdcG /��i�s�/i Cu,cQ � ru.T�� P•F,E s_Fcr.o.✓ 3,3, � V♦ <br /> pF7�F Gity S;ANnA,�.�s �3oO,c". <br /> �v,�w ,�,�.v.�.va/ �s ro c� z�,�s,-�c��o �,� s:r�No��.o �3oT O <br /> 5. a„ <br /> ACKNOIVLL-DUEMENT OF CONUITIONS <br /> The undersigned o+vneUapp�icant hereby r.g�ees lo hold and save haim- <br /> — less the CAy of Everelt Iror.i any and all claims :or damage.. costs. <br /> expenses. or causes ol ac"�on that may arise be:ause ot �,s�allation <br /> � d anA maintenance of �he ^ �e�:ement �r olher iiqht�ol�waY usc tereto <br /> � applied for and Iwlhei � s to iemove same upcn notice Irora the <br /> Approved tor Cons ��/ � Uate �;ty and to replace uUl� �erry damayzd ihereby. <br /> � <br /> ;� . . <br /> � �� �-/.FG ' Z -8=ge <br /> FINAL INSF ION Date - Da!e <br /> SignaP�rr, cl App��.ant <br /> ApprovedasConstructed WORK 1UTI10FiIZED BY THIS PEF;MIT MUST BE STAR7ED WiTHIN <br /> evereu PUBLICWOHKSDEPARTMENT i80 DAYS OF DAi[ PEHMIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200 Cedar Street BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT 1.1AV BE <br /> Evereit,WA 98201 CANCEI_LED BY THE CITI UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone�.259�8810 PROJECT OVER 90 DAYS DUR�TION. <br />