Laserfiche WebLink
u <br /> a7i°. / <br /> Date�� auoocwo�eePerm�t. __��ri� 3°}7�/ / <br /> Biaq Deat• � <br /> � Appliwtion For - <br /> PU�LIC WORKS PERMIT P°°;o„F�a`Pe S ��>a9 = <br /> p Les�4001.Fee Paia �� <br /> Print or Type Only� � � � Baiance Due s -��'9 <br /> .� : � 5�_ ���o <br /> � � N � <br /> /'�'u /es 33 2�/�c% . A(E. Sea{f� GUA 98/77 <br /> Owner � `� Mailing Add�ess City Lp Phone <br /> � a � �' <br /> Sc�'/h� R S AGeve. <br /> Applicant Mailing Address Ciry Zip Phone <br /> Describe Proposed Work l�0 ady �/�ti SP�p+" � Q �9(� �Q Te,� (_.Dit ST/Y!�/Oia <br /> Per APprouPd ansf.wo ,�., P/ans <br /> Proiect Address lif known� 5/2 �"UAv � <br /> � <br /> Attach fow(4) copieu ol plans lor proposed work� D�aw to scale and note Ihe lollowing as applicable: � <br /> • Pronerty Lines • Genterline ol sireet � <br /> • Outline and dimensions of all ezisting and • Indicale North <br /> proposed structures on�he lot • Show any propused grading changes <br /> • Ezisting and proposed utililies • Show measuremeNs � <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 1.All calls for inspection shall be made 24 hrs.in advance-phone 2�J9•88�0. � <br /> 2.All work shall be pertormed in accordance with this permit and current City of Everetl Design and Consiruction <br /> Standards and Specilications. <br /> 3.Call Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1-80�-424-5555. � <br /> �J. /'� Gy�J�-�%/�,�mS �Irr�c� 8-is�-�v O <br /> /'/ <br /> ♦1"/�� <br /> , } v+ <br /> �f � � p <br /> �,��,Lr ,: <br /> � �,., � <br /> _ ������, � a <br /> ���/�,��� �E�. f <br /> ACKNOWLEDG[MENT OF CONDITIONS <br /> The undersigned owner/applicanl hereby agrees to hold and save harm� <br /> � less ihe Ciry ol Everett Irom any and all claims for damages, cos�=. <br /> ��i��- eapenses, or causes of adion Ihat may arise because ol installati�� . <br /> / � ���� (�>/S/ and maintenance ol Ihe impiovemenl or other right-of-way use hereP� <br /> % ������ SJ applied for and further agrees to remove same upon notice Irom the <br /> A�p ved lor C6ns `ion / - ate City and to replace public property damaged thereby. <br /> � :`��~�� _ ��_;� _-2��� `'��/9� <br /> FINAL SPECTION Date� <br /> ApproveA as Constructed Signature of Applicant ��� ��.�' a e <br /> evcrett PUBLIC WORKS DEPARTMEN7 WORK AU7HORIZED BY THIS PERMIT 7J�U5T BE STAPTED WITHIN <br /> � 3200CetlarSireet 1B0 DAYS OF DATE PER1�11T IS ISSUED AND THEREAFTER IS TO <br /> Everetl,WA9A207 BE DII_IGENTLV PURSUED TO COMPLETION. THIS PERMIT MAY B[ <br /> Phone:259�8810 CANCLLLED BY THE CITY UPON ANV STOPPAGE OF WORK ON THIS <br /> PFOJCCT OV[R 90 DAVS DURATION. <br />