Laserfiche WebLink
'i <br /> I4� � . ,-,_ / <br /> Date�$,/ � �-'� Z� �S �u�i¢Wo�knPerm . � Z���� <br /> � � Appliwtion For BI00 Depl • <br /> PU�.IC WORKS PERMIT Puouc�vo�F�rec g -- <br /> Tolal Fec <br /> O <br /> Q Le55 Ap01 fec Paut $ <br /> � pOI^ O O p O OM � <br /> � � OOG�Ifl O [� �J O T Baianceouc S �� <br /> Print or Type Only� � �o��� o 0 0 0� vi <br /> M � W M N U [�`1 � � W J <br /> p >� (� p � <br /> �J�__�-�g.� �s��� .� ��/d�r� T�ZZ���1 SS'—���fa <br /> Owner u �� �y N l e li(�� �s o w�� C�ty Zip Phone <br /> ... or� �v�.zv� 30 �- 0 � � w <br /> \ O ;JWJ CCO � Ol i <br /> Un���a,�� r-1��`�J `�" L /ztJ��!/�t� �.Rry3(o 3G 7-8`ya l <br /> Applicant Mailing AUdress ity 2ip Phone <br /> Describe Proposed Worn NPLI� I Iii n�P J� L d� / PY .r/� <br /> / <br /> W <br /> Project Address lil known) , 1 � �z' A�6 — '��I P Cq 1 hi �� ��E � <br /> Atlach four(4) copies ot plans lor proposed work- Draw to scale and note ihe lollowing as applicable�. � <br /> • Properiy Lines • C?nterline of street /� <br /> • Outline an�dimensions ol all existing and • InAicate Norih V� <br /> proposed strudures on the lot o Show any nroposed gratlin9 changes <br /> • Existing and proposed utilities • Show mea�uremenis � I <br /> DO NOT WRITE BELOW THIS LINE O i <br /> PERMIT CONDITIONS <br /> 1.All calls for inspeclion shall be made 24 hrs.in advance-phone 259•8810. � <br /> 2.All work shall be pertormed in accordance with this permit and current City of Everett Design and Consiruction <br /> Standards and SGecilications. <br /> 3.Call Location U�derground Servic� 48 hrs.belore you dig.TOLL FREE NUMDER 1-800•424•5555. � <br /> � <br /> ■ I <br /> N ( <br /> O <br /> a <br /> �/ ACKNOWLEDGFMENT Of CONDI - � <br /> 'TLL The unders,yred own�r/applicant hereby ayrees I �, �,and save harm- � <br /> � less the City ot Everett fmm any and all claima danages. ccsts. <br /> expenses, or causes ol action that may arise �ecause ot installation �i <br /> "� 1e�1 6and mainlenance ol the improvement or other right-of-way use hereto � <br /> "(—CA ' yy` G�LCA �–� � _ J� applied fcr a^o �.�ither agrees to remove same upon nolice Irom the i <br /> Approved tor ConsVu� Date City and to replace public property damaged Ihereby. <br /> i <br /> ,�0.�i'��/— 2-2B- 9j �r-^- �' �, II <br /> FINALINSPECTION Date `�"'������� �/a� i <br /> Approved as Cons�ructed Signature of pplican� Date I <br /> WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> evcrett PUBLICWORKSDEPARTMENT 180 UAVS qF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200CedarStreet 9E DILIGENTL\' PURSUED TO COMPLETION. THIS PERMIT MAY BC <br /> Everett,WA 98201 CANCELLED BY THE GTY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phane:259-8810 PROJECT OV[R 90 DAYS DURATION. <br />