Laserfiche WebLink
Date�� u/FS Puoi�cJJoiksPermu� l �s� ��'Sr <br /> Application For BICg OeO��• � � <br /> PUBLIC WORKS PERMIT Puoi�cWoresFee <br /> To:al Fee S <br /> Le55 Rppl Fee POid � <br /> Balanca0ue S Zn�C� <br /> Print or Type Only <br /> ����'� <br /> �A�ItD �/1�- aAlct� 1�.D .�ir 2'zl�q Lvnnwuo� c1�034 742-7830 <br /> Owner Mailing Address City Zip Phone <br /> Applicant Mailing Address City Zip Phone <br /> De� ribe Proposed Work �7\Y�sk ��hA���. 1`�l�l1Lc, — IVCl..�.)�nN�l.f�l.l ��p r� _ <br /> Project Addres• 'known) ���I ��� ���G � <br /> � <br /> Attach lour(4)copies of plans lor proposed work- Draw to scale and note'`,e(ollowing as applicable: � <br /> • Prope�ty Lines • Centerline ol s�reet � <br /> • Outline and dimensions of all ezi=ting and • Indicate North <br /> proposed structwes on tr e lot • Show any proposed gradin�changes <br /> • C-xisting and proFosed u�.ililie: • Show measmemenls � <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> i. All calls for inspection shal'be made 24 lirs. in advance- phone 259•88�5. � <br /> 2. All work shall h�performed'n a-�ordance wilh this permit and currenl City ol[veretl Design and Consiruction <br /> Standards and Speciticat�ons. <br /> 3. Call Localion Underground Servi;:e 48 hrs.before you dig.TOLL FREE NUMBER 1•800•424•5555. � <br /> /, .��'s'�icai✓� /S iEFqc�.�Fv 7� fAriE 34�"�' S�r. — 2,4- ff, <br /> LL%!)E PE�' C�� STi1ND<I.e.CJ '�3?_G� ACLLi.=O.NG Tv O <br /> L7C�DiNd.L�CE� S�-`�' <br /> .>�, /�fi�L�Gd.vi N/icG G'E �'EGfGi.�'EO %� /�.C''OG'/!)f � � <br /> /-c'��OKi�ld�.'CE 4l/4.�dNT✓ ��' .ST.c'EE7 �.4/�i.C�Lr. � <br /> / O�, ��,�,� c2��t1E �,c� Sh'1.�.�J" Sr•eEET Tc� E-rresE T.rE <br /> SE�IE.�� /»A,.�/ �,,�4j� .C'ECL'i.EE f�si�iec.r /?cc..,f/G- 7�' � <br /> �(ESrn.�E 7�/f Si.�rET. <br /> j, Ti�E LuvTE.c 1�Ei�� _ />a5 �C.cEEL� Tc- A.114E Sr n�c�✓T 7,�A�E�i' <br /> %C� iE.cG:�E TiiS %.Co/=�.e�Ty Til.EO�'C-i/ <br /> �N,q„� Exr�-�o�,vc- T��� w��Cf-� ���"/� ACKNOWLEDGEMENTOFCONDITIONS <br /> ,��Vho{7:2( /!�y �'j The undersigned owner/applicaN hereby agrees to hold and save harm- <br /> - less the City of Everett irom any and all claims foi damages, cosis, <br /> / ezpenses, or causes of action thal may arise because of installation <br /> ����/� �/�J_�� and maintenance ol �he impwvement cr other righbol-way use hereto <br /> �—�"�'-'�"'7 apPlied lor and further agrees to remore same upon notice Irom the <br /> Approved for Censiructi� Date City and to replace public property damaged thereby. <br /> � 3-/S� `I1A11 1f�1- IL <br /> INAL INSPECTION Da;e 1�� �O 1`""��u— (� I��I� <br /> Approved as Consiructed Signalure ol Applicant Date <br /> everetl PUBLIC WORKS DEPARTMCNT WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> � 3200 Cedar Slreet 1B0 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everelt.WA 98201 1iE DILIGENTLV PURSUED TO COAIPLETION. THIS PERMIT MAY BE <br /> Phone:259-8815 CANCELLED BY THE CITY UPON ANY STOPPAGE UF WORK ON THIS <br /> PROJECT OVER 90 DAYS DURATION. <br />