Laserfiche WebLink
Date ��� r„ni�cwo�eeac�mn. <br /> Application Fo� omo o«n� . Sp� <br /> PUBLIC WORKS PERMIT �uni�cwa�kefee - <br /> iotnl Poe s <br /> Leae ApPI Fnc ParE S <br /> Balance0ue S <br /> Print or Type Only <br /> Y}'ln Yv�. ��y�z�� lf�zr L.1e��ct�a /�✓a G�P�nf� 9820 / 7�/5-Q�� <br /> Owner Mading Atldress Cny Zip Phone <br /> S.a4l�"�m..,,..., P rtc! 1� 2 cil,� �09'K Fl S �����98�/S� 5 Fr-�-3�3 6 <br /> Ayplicant Mailing Adtlress Cdy Zip Phone <br /> Desr.ribe Proposed Work �_4C IC � .SiN�f(„ '�ly,� ��i Q,�� _ <br /> — — <br /> - �J W <br /> Project AdAress lil known) � G����� ��l� /J�A6 � <br /> Attec�four(4)cop�es ol plans lor proposed work• Diaw to scale and note Ihe�ollowing as applicable: � <br /> • Property Lmes • Centerline ol siree: � <br /> • Outline and dimensions of all ezisting and • Intlicate North <br /> proposetl structures on ihe lot • Show any proposed grading changes <br /> • Existing and proposed utilrties • Show measurements � <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 1.All Calls tor inspection shell be made 24 hrs.in sdvance-phonr.2S9•8E�c"�. � <br /> 2.All work s�all be pedormed in accordanCe with this permit and wrren�City ot Everett Desgn and Construction <br /> Standards and Specifications. <br /> 3.Call Location Underground Service 48 hrs.before you dig,TOLL FREE NUMBER 1•800•4245555. � � <br /> O <br /> ��v��� �vo,�.� f E���T-/dET��QU,;���o a�88 � <br /> c � <br /> O <br /> a <br /> ACKNOWLE�G[MENT OF CONOITIUNS <br /> The undersiqned owner/applicant hereby agrees to hold antl save harm- <br /> — Iess Ihe Cdy ol Everetl Irom any and all claims tor damages. cosis. <br /> expenses, or causes cl action that may arise because of inslallation <br /> and maintenance of the improvement or othcr righbol-way use hereto <br /> applied lor and furiher agrees to remove same upon notice Irom ihe <br /> Approved for Construction ���� Cdy and to replace pubhc property damaged thereby. . <br /> PINAL INSPECTION Date <br /> Approved as Constructed Signature ol Applicant Date <br /> WORK AUTt�10Ri2[D BY TIiIS PERMIT MUST BE 5T5RTtD WITHIN <br /> everell PUBLICWOFKSDEPARiMEN7 �g0 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200 Cedar Street BE DILIG[NTLY PURSUED TO COMPLETION. THIS PEPMIT MAY BE <br /> Everett,WA9820t CANCELLED BY TH[CITV UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone:259�0810 PROJECT OVER 90 DAYS DURATICN. <br />