Laserfiche WebLink
' ^���,�« �" p�STING �' � e � � <br /> � PUBLIC WORKS PERIrAIT °°�° <br /> PUBLIC WORKS D�ARTMENT Publk Nbrks PermH N �� w� <br /> 3200 Cedar S6eet <br /> EverM�,WA 98201 �.::. 259-8810 Building PertnN A <br /> �'" <br /> r. �-. <br /> TYPE OR PRINT ONLV ,', �� ,, PuWb Waxa Fee S�_ <br /> � r� <br /> MN�K Ro44f 5409 S,C,d'il�wST •, £Y�t�T 9$2°3 2`�p£'96G <br /> Owner MadmgAddress -. �. c- Ciry Zip Phone <br /> I��1 f] ��I f ". <br /> r.� r'� -� i i <br /> �.: (: <br /> �., x i <br /> Appl;cant Mailing Address City Zip Phone <br /> Desctibe Proposed Work �lC .S/t� 1��'GL /N TU G 3 /N �G/�f 0 F W/Q �'� W <br /> � <br /> � <br /> PROJECT ADDRESS(it known) S4 09 t EA/�✓K$T � <br /> Attach four(4)coples oi plans for pmposed work-Drew to scale and ncte the following N applkable: � <br /> �Property l.ines �Outline and dimensions o1 all existing and proposetl structures on the bt 'Existing and proposad utilities O <br /> 'CenteAine o:sireet •Indicate North 5how any proposed gratling changes •Show measurements � <br /> DO NOT WRITE BELOW THIS LINE <br /> PERMIT CONDITIONS: � <br /> 1.All calls for inspection shall be made 24 hours in advance-phone 259-8810. O <br /> 2.All work shall be perfortned in accordance with this permit and current City of Everett Design and <br /> Construction Standards and Specifications. <br /> 3.Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800-424-5655. � <br /> �. AS pe✓ Pvhl,� G1�i�'�S �nS�t�r�' d,�tt�o., ;,, � <br /> -�e�d. - C�, �( 339 �� ��-�zr fo m�r �,h� a <br /> ('�v�/lP.�f� o� � G, 3. <br /> �� <br /> ACKNOWLEDGF.MENT OF CONDI710NS <br /> 3 �7 The undersigned owner/applicant hereby agrees tc hold end save harmless <br /> GS �� the City of Ereretl from any and all claims for damages,costs,expenaes,or <br /> Appro ed or Constru n Date causes o1 aaion that may ense because of inatalletbn and maintenance of <br /> - the improvemant or other right-of-way use Mreta appiied fa arW fuRher apraea <br /> to remove same upon notica hom the CiTy and to raplece public property <br /> ,ry � l�y_s � damagedthereby. <br /> �AL INSPECTION Date <br /> Approved as Constructed �/Z C/a� <br /> J�� <br /> Signature o Appli t p�e <br /> WORK AUTHORIZED BY hi�S PERMIT MUST BE STARTED WITHIN 1B0 DAYS OF DA7E PERMR IS ISSUED AND THEREAFiER IS TG BE DILIGENTLY PUR$UED TO <br /> CqMPLEfION.7HIS PERMIT MAY BE CANCEU.ED BY 7HE CITY UPON ANV STOPPAGE OF WORK ON 7NIS PRWECT OVER 80 DAVS W RAiION. <br />