Laserfiche WebLink
Date�-Z5-8'y — P„„�,�wo,.,�.,m�p. _ <br /> APPGcalion Fo� ema oeni • —Q__��Z3rL�]_ . <br /> PUBUC WORKS PERMIT �•���;�,W�;��eO—s=`���� <br /> i ess nnni fa•v.,o S_ <br /> Print or Type Only oa�.,���o�� s <br /> � m�ckG) C�CO �QZfL�LL�U/` ,�„P��� 9d�zoi Z�i-2 `��2 <br /> Owner Mading AAtliess Cdy 7_ip Phone <br /> kj N1,Q <br /> Apphcant Malling Addiess Qty Zip PhOne <br /> Describe Pioposed Work _ �P1(�.�� ��T!e JP 1w���-f T,�G�Om irl� �� � <br /> �Tln/'�/n l7,2/�/�iZT <br /> S,. , �e�- /�G /2� <br /> P�oject Address I�f knownl ��6/.—�(��-�L_'�-7L•� � <br /> Altnch Iour 14)cop�es ot Plans tor propoeed work� Draw lo scale anA nole Ihe tollowing as applicable: � <br /> • Propeny Lmes • Cenlerfine of street � <br /> • Cotllne and dimensions ol all erisling antl • Intlicale NOrih <br /> proposed siruclures on the lol • Show any proposed grading changes <br /> • Ecisting and proposed utiiities • Show measurements � <br /> DO NOT WRI7E BEIOW THIS LINE <br /> PERMIT CONDITIONS O <br /> t.All calls for inspectlon shall be made 24 hrs.in advance�phone 259•881 O. � <br /> 2.All work shall be pertormed in acco�dance with this permit nnd current Cily of Everett Design and Construction <br /> Slandarda and Spec:ifications. <br /> 3.Call Locetion Underground Service 48 hrs.belore you di{7.TOIL FRE'c NUMBER 1•800�424•SSS5. � <br /> � O <br /> ���' " ' <br /> .�.��.:�c�oz..�� � <br /> ( i��'( �-'�e�/_ � <br /> ��g/�� O <br /> � <br /> a <br /> ACKNOW�EDGEMENT OF CONDITIONS <br /> The undersigned owner/applicanl hereby agrees to hold end save harm- <br /> — less the City ol Everetl irom any and all claims br damages. costs. <br /> eapenses, or causes ol aclion that may arise 6ecause ct installation <br /> and mamlenance ol Ihe Improvement or other righl-ol�way use hereto <br /> Tpplied for and lurther agrees to remove same upon notice from the <br /> Appmved lor Construction Date City and to replace pubhc property damaged thereby. <br /> hIWAL INSP6l.iliJN Date <br /> Approved as Constructed Signatme ol Appllcant Date <br /> everett PUBLIC WORKSDEPAR7MENT WORK AUTHORIZED BV THIS PERMIT MUST BE STARTED WITHIN <br /> � 3200CedarStreet 780 D�YS OF DATE PERMIT i5 ISSUED AND THEREAFTEI7 IS TO <br /> Everetl,WA 99201 I3E DILIG[NTIY PURSU[D TO COMPLETION. THIS PERMIT MAV BE <br /> Phone�259�8810 CANCELIED BY THE CITY UPON ANY STOPPAGE OF WORK ON THI� <br /> � PROJECT OVER 90 UAYS DURATION. <br />