Laserfiche WebLink
; <br /> __ Yo- yO.> <br /> ✓' <br /> ��'y�)��y( PuOLc Warke Permn• <br /> Date=.�-'+'-+' 6mg Deo� • ���� <br /> .i ppplication For _ <br /> � PERMIT <br /> PUDI¢WorAs�ee S <br /> P����IC WORKS 1alalFee <br /> G Lesf ApO� FeE Pai�1 g� <br /> �1 �� <br /> LJ � ��tlpflCC�UP � <br /> c., ��L q,✓ <br /> Print or Type OnlyLL; �_; � <br /> , f�✓..E"l:., p�JG <br /> "! i,� //�i�p � �1 c,"O o <br /> �/I�/ Cr ��-7iT'`a �_ S ✓lcCPi .�OQ.l G.JG' T>J70/e F %�yvl C S � ' } <br /> Zi Phoi c <br /> ����ef � ro,. � ? n,ailiny Atldress �'�Y p <br /> - ��.� f] LL. 'fC <br /> � �5 <br /> iyi _.. .-. —_— <br /> �[y/ �� Phone <br /> . � ApPlitant <br /> Maihng Address Ciry Z�P <br /> �. � , �s;. O j j � `G*-c ���—^-`� �+�h.�--'�/ - <br /> ' Desc��6e P�oposed Work�y_s�-- <br /> W <br /> ' k ti n /."'. �' –P– "i e I`15 ^�`' +�x.C" �I � <br /> ' t �, <br /> Prolect Address lif known� — <br /> Attach four(4)copies o� plans lor proposed work- Draw to scale and note�CPo1`e line of stPee�cable: � <br /> • Property Lines • InAicate North <br /> • Outline and oimensions ol all exlsting and � ghow any O�oposed grading changes <br /> proposed slructures on Ihe lot � Show measurements M <br /> • Exis�ing and proposed ulililies W <br /> DO NOi WRIiE BELOW THIS LINE O <br /> �ERMIT CON�ITIONS � <br /> 1.All calls for inspection shall be made 24 hrs.in advance-phone 259•88 i 0. <br /> 2.All work shell be pertormed in accordance wilh this permit and current Gity ot Everett Design and ConsUuction <br /> Standards and Specifications. � <br /> 3.Call Location Underground Service 48 hrs.betore you dig.TOIL FREE NUMBER 1•800'424•Sb5 . <br /> �.�c;'� ���' `�"� <br /> 5! /��Of,� �� ./��' ������'�r-4�r�/o�-cr�' /Y,���;" O <br /> r <br /> N <br /> O <br /> a <br /> ACKNOWL[DGEM[NT OF CONDITIONS <br /> The undersigned owncr/applicant hereby aurees to hold and save harm� <br /> less the City ol [verett Irom any and all •;lalms lor damages costs. <br /> expenses. or causes o1 action that may anse 6ecause of installation <br /> � �� /� %� n anA mainlenance of lhe improvement or other righl�ot�way use herelo <br /> l.�i��/J?T�':� Cl '��' �n applled for a��.d lurther agrees to remove same upen notice Irom the <br /> Approved for Consiruct��� <br /> Dale City and t�. replace public property damaged thereby. <br /> '2 -�7 _ �_C • nc_�o n/ �n�� 8 �� <br /> Date � ��j / � /Date <br /> FINAL IN EC ION Signature of Applicant <br /> qpprove as onstnicted WnRK AUTHORIZED BY THIS PERMI7 MUST BE STARTED WITHIN <br /> everett PUBLICWORKSDEPAR7MENT 180 DAYS OF DATE PERNIT IS ISSUED AND THER[AfTER IS TO <br /> � 3200 CeCar Street BE DILIGENTLY PURSUED TO COMPLFTION. TNIS PERMIT MAY BE <br /> Everett,WA 98201 CANCELLED BY THE C�TY UPON PNY STOPPAGE OF WORK ON THIS <br /> Phonc:259-�810 PROJECT OVER 90 DAVS DURATION. <br />