Laserfiche WebLink
Puoiic worha Pe�mn��� �� <br /> Date o-a - �3 9ieQ Deo� ' <br /> Applicaticn For <br /> PUUI¢WorkeFee S�� l4'O <br /> PUBLIC WORKS F'ERMIT To,e,F« <br /> �eae evo�Fee Pe�e s� <br /> Balanca Due s� <br /> Print or Type Only �'s��, <br /> �c..����r � 9�ao� �-s� -6>� 6 <br /> (Z I� or< i 3/ O ' Qvc; ,p � ,,..,... <br /> Maihng AddresS �' Y <br /> O � <br /> /� � � / Ci� Gk- R� a� �l� 98�.4D ?J��� <br /> � ln r ^�-Y �� Ph e <br /> �� �� Mading Atltlress ���Y <br /> Applicant <br /> dJ .O / gQ ' '� � x�� �� h„ �Id� <br /> Destribe Proposed Work J A /�� —_---- <br /> G� w,c��'��u ' Tlf� — r <br /> ♦ n � � <br /> � �� ' � <br /> Prolecl Address(il known) � � <br /> Attach lour!4)copies ol plans for proposed work� Draw to scale and note�Centerline of�pee�a�le�. � <br /> � property Lines • Indicate Norih <br /> • Outline and dimensions ot alf ezisting and � Show any pro0osed 9�atling chan�es � <br /> proposed slruclures on ihe lot � =how measuremenls <br /> • Esistina and proposed utilitirs <br /> DO NOT WRITE BELOW T41S L.INE O <br /> PERMIT CONDITIONS � <br /> 1. All calls for insped.on shall be made 24 h�s, ir �c'vance- Phone 259'BB�5. � <br /> 2, All work shall be pe�'ormed in accordance wi0� �nis pc�mit and r.urreN Clry of Everett Desipn and Construction � F <br /> Standards and Specilicationa �- <br /> 3. Call Location Underground Service 48 hrs.before you dlg.TOLL FREE NUMBER 1'800•424•5555. f <br /> r: <br /> 1 -sl� � s, � � � ^ <br /> � � l �� ec ckaJT'+K �' ���• m� <br /> t ,�� <br /> ' -T L / n �� q..9 �1-k� o�as -� � .r: <br /> � b� e.\e.a... e.J '..� , , � <br /> I �.. -�k...�(—.. N � � <br /> CLL� fG�A1ft G °"'��c�� fC{� � G�et� ^ ` UI � <br /> pn,�e,,-� , G'o.�.�G.e� -1�Ct Q..bl�i... Wm.�., � ��e�de✓ O G � <br /> ` m <br /> � ' N ,�u,.� ' � �-G.� C. C3. �... � P 0. � <br /> � :ar <br /> rovw s. � � <br /> $. `C oo� -e�rw• .�. 1 t,.,�.. s 1- b c -�=�Sln,�- �,•.e .Q i... � C , 3. > � � <br /> �^T a-. Q��.a s, 7 e� rJ s <br /> tor �.,_.� Sa-���t�� S[�.-�6� ��KNOWLEDGEMENTOFGONDITIONS � � <br /> The unAersigned owner/appiican�hereUy agrees to hold and save harm- F-�2'- �. <br /> less the City ol Everelt 1rom 2ny anC all claims for damages, cosis, <br /> —�—� /J expenses, or causes ot action that may arise because ol installalion � <br /> ` �(//� and maintenance o� ihe improvemenl or other n9ht-o4way use hereto <br /> �� /o-o7G-�3 applied for and turiher agrecs to remove same upon notice trom the � ; <br /> ��� Date <br /> City and to replace Public property damaged thereby. � � <br /> ppro�ed lor ConStruciion ,. <br /> � � � s /' ' ` <br /> ��%�> i�/i,%.�C<-C_ jl-�' ' � � �� A / .� ,( ` n /O�.�Al�3_ � �. <br /> / Date --4�--- � t�a�e <br /> FINAL INSPECTIOIJ Signalure ol AS�PIicaN =` <br /> ApproveA asConsiruclerl WORK AUTHORIZEO BY THIS PERMI' MUST BE START[D WITHIN <br /> PUfSLIC WORKS DE�ARTMENT 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> evcre[t BE DILIGrNTLV PURSUED TO COMPLETION.THIS PERMIT MAY BE <br /> � 32C0 Cedar Street <br /> Eeeretl.WA 982�1 GANCEILED �Y THE:ITY UPOtJ ANY STOPPAGE OF WJAK GN THI <br /> Phane-259-�815 PROJECT OVEF °0 Df.YS CU�ATION. <br />