Laserfiche WebLink
Date i�•'Yr a'� • • r�nu�«o,.:c�,m�. 1 <br /> Application For e�aq.ocu+ � ___� J �� <br /> PU�LIC WOFtKS PERMIT P����°w°«9FeB — <br /> ,o�a�F�o s <br /> � Less Aoo�.Fcc Paid $ <br /> Print or Type Only ea�a��eo�� s <br /> ��. M� G,��,�r ��� ,��;�.,�,� p�. c��- �x�3 as a-8 a s�3 <br /> <-+�ner hlailing Address City Zlp Phone <br /> �../Yf_ �i�ro.�E '�+y'O� �c�C i�✓V�r2_�—i,�uzPs? �3 asa-8-a�3 <br /> Applicant Mailing Address City Zip PhOne <br /> � �� �, � ' � i <br /> Describe Proposed Work .�L�!��'� �Z X �S�Z ��'�`Zc'��'"� 7a �"/-1?ji'�'6 /� USG <br /> Projecl Acid�ess(it known) �7�S G���-IcE�SC �.�,.�'YL�� / C�o2S.�/ � <br /> A�tach four(4)copies ol plans lor proposed work- Draw to scale and note�he lollowing as apPlir.a6le. � <br /> G Pi�u�d� Lines • Centerline ol street � <br /> • Outline and dimensions ol all existinc�and • Indicale Norih <br /> proposed structures on Ihe lot • Show any proposed grading chanaes <br /> • Existing and proposed ulilities • Show measurements <br /> DO NOT WRITE BELOW THIS LINE � <br /> PER�dIT CONDITIONS O <br /> 7. P:I calls for inspec�ion shall be made 24 hrs. in advance� phone 259•88�5. � <br /> 2. Ail work shall be performed in accordance with this permit and current Ciry of Everett Design and Construction <br /> Standards and Specifications. <br /> 3. Call Location Underground Service 48 hrs. belore you Aig.��OLL FREE NUMBER 1-800-d24•5555. � <br /> /��['� f�C�f:.C: GS'cl,c',E:s' f'c—i'.-vi" ;l?=�c5'c..v.C'�=.v � O <br /> �/s',����/ <br /> � <br /> � <br /> � <br /> a <br /> ACKNCWLEDGE�IENT OF CONDITIONS <br /> The under,igned own=d.•�pplicant hereby ag�ei;s to hold and save harm� <br /> � less ihe City ol Everet; irom any and all cWims lor damages, costs. <br /> expenses, or causes ol aclion thal may arise because ol installation <br /> and maint?nance ol Ihe improvement or other ri�ht�ol•way use hereto <br /> applieA lor and funher agrees to remove sama upon notice Irom the <br /> Approved for Construction Date City and to replace public propeity damaged thereby. <br /> FINAL INSPECTICN Date <br /> App�oved as Consti�cted Sic�natwe ol Ap��licant � Date <br /> rverclt PUBLIC WORKS DEPARTMFNT WORK AUTHOfiIZED BY THIS PERMIT MUST BF. :�TARTED WITHIN <br /> � 3200CedarSireet 180 DAYS OF DATE PERMIT IR ISSU�D AND THEREAFTER IS TO <br /> Evcret�,WA 98201 BE DILIGENTLV PURSUED TO ' MPLETION. TH18 PERMIT MAY 8E <br /> Phone: 259�8815 CANCELLED f3Y THE CITY UPC� �,NV STOPPAGE OF WORK ON THIS <br /> PROJECT OVeR 90 DAYS DU�, �,TION. <br />