Laserfiche WebLink
R <br /> �. _.....,'� <br /> F <br /> I <br /> ���yy /—d_�-/� ; � � � r�oi¢wa.sromn• <br /> � � Date�s:. � � C�/�� <br /> eiap Deo� •�L/ -� <br /> AppliGation For <br /> ��� PUSLIC WORKS PERMIT ��m��wmk.r« <br /> totaiFee S <br /> ��� lesaAp0lieePab $ — <br /> Bennc�oue S_ <br /> Print or Type Only <br /> �o}��(''�� �., , � � i 1, <br /> Fy p Owner ` MaiVing Atldress City Zip Phone <br /> O• <br /> �� Applicanl MailingAddress City Zip P�one <br /> �� DescribeProposedWmk _.�1.L'L-[1s ��� � � — — <br /> O� <br /> + Projecl Addre�s lil known) _ '�-��`�"`1 ��-' �-`"'� �� � ' � <br /> Atlach lour(4)cOpies ol plans lor proposed work� Draw to scale and note ihe following as appticahle: � <br /> • Property Lines • Cenlerline ol street <br /> • Outline and dimensions ol all exisling and • Indicate North <br /> . . proposed siructures on ihe lot � Show measu.-eme d gr,�ding chanyes � <br /> • Esisting ane proposed utilities <br /> % �\ DO NOT WRIiE BELOW TIi15 LINE O <br /> i ��� PERMITCONDITIONS <br /> 1 � <br /> � 1.All calls br inspection shall be made 24 hrs.in advance�phone 259• . <br /> 2.All vork shall be peAormetl in aGcorJance with Ihis permit and current City ol Everett Design and Construction <br /> �_ ��andards and Specilications. <br /> � ?.Call Location Underground Service 48 hrs.belore you dig.TOLL FREE NUMBER 1•800•424•5555. � <br /> � <br /> ' �� �� i��u i I-/Zl%� C-�C�' .L�2t�(� 0 <br /> '� H� ��'�rl� N�Z�� `�rv�2. �a-LT 2-��ii � <br /> ��-�� ��� <br /> N <br /> �' L 1�1�'<< Q <br /> , c��_ 1 � <br /> , a <br /> �_I i �i ����, <br /> iACKNOWLEDG[MENi OP CONDITIONS <br /> ��'_t — Tne undersigned ov.�ner/applicant hereby agrees to hold and save harim <br /> less ihe Ci1y ol Everetl Irom any and all claims tor tlamages. costs. <br /> expenses, or causes ol aclion Ihal may arise Uecause ol installation <br /> and maintenance of the improvemenl or other ngM-of-way us� hrrelo <br /> applied lor and further a9rces lo remove same upon notice irom the <br /> ApP�oved tor Construction Date City and to replace public property damaged thereby. <br /> FINAL INSPECTION Date — �,��� <br /> Approved as Consiruded Gignalure ol Applicant <br /> WORK AUTH(JRIZED BY TI115 PERMIT MUST BE STARTLO WITHIN <br /> rve«�11 PUBLICWORKSDEPARTMENT 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO ' <br /> � 3200Cedar5lreet BE DIUGENTLY PURSUED TO COMPL[TION. THIS PERMIT MAV BC- <br /> Everell,WA98201 GANG[LLED 8'!THE CITY UPON ANY STOPPAG[OP WORK ON THIS <br /> Phone:259�G810 PROJECT OVLR 30 DAYS DURATION. <br /> I <br /> � <br /> i <br /> il t . <br />