Laserfiche WebLink
�f � <br /> Q� � 9Gr �uelic Worke Permit• � <br /> Date �"�J �� <br /> BI.p.Deo�• <br /> Applica!ion For <br /> PUBU�" WQ�RKS PERMIT °°°"""°",`°° s ��`� <br /> To1�l Fee <br /> Lesa RPG�Fae PalO f <br /> Ba�ancaUue s ���_ <br /> Print or Type Only <br /> � <br /> Fi•A.�� l�l. 1;// �/D� �3��1. /vr. G�. �✓r���� Gf.b. 9P�o3 S3-X 3i <br /> - Mailing Address City Zip Phone <br /> Owner <br /> /-�i-s.,,� C�/. . // .S/D/ �3 r� �� C<1, Evc��fz� LrJc 9d'� v 3 � 3S3-� 3� <br /> Applicant / <br /> Mailing Address City 7_ip Phone <br /> Des,�'ribe Proposed Work <br /> Ii�SLff/� Q �aZ`in�� SidrGJu�.F O�7A .i1U:�d O <br /> Trn�t on Lli <br /> W <br /> Pro�ect Address(it known) S� � 2 3 � � <br /> � <br /> Attach four(4)copies ot plans for proposed work- Dr v+ :u scale and note the followinq as applicable; � <br /> • Property Lines • Centerline of sireet <br /> � Outline and dimensions of all existing and • Indicate North <br /> proposed struclures on Ihe lot • Show any proposed�rading changes <br /> • Existinq and proposed utliities � Show measurements M <br /> W <br /> DO NOT WRITE 9ELOW THIS LINE O <br /> PERMIT CONDITIGNS � <br /> 1. All calls for inspection shall be mede 2a hrs. in advance• phone 259•881 5. <br /> 2. All work shell be performed in accordance with this permit and current City o(Everett Design and Construction <br /> Standards and Specifications. � � <br /> 3. Cal! Location Underground Service 48 hrs.betore you dig.TOLL FREE NUMBER 1-800-424-5555. <br /> F <br /> � y�" ��,r��;u,� .�'�-,�,- q � <br /> S <br /> �%yc ,o�� �'�'«,� � ��s�T�'-�U�v� .�oi�G� � <br /> �/- �'na- s�l r1 - SSSs� (� � '' <br /> O � F <br /> � � <br /> a, r. <br /> � <br /> F <br /> � �: <br /> � <br /> ACKNOWLEDGEMENT OF CONDITIONS p %�� <br /> The undersigned owner/applicar.t hereby agrees to hold and save harm- <br /> less the CiN of Everett Irom any and all claims lor damages, cosls, � `� <br /> ��'))) expenses, or causes ot action that may arise because ol installation <br /> �j � �j�—_ p and maintenance ot ihe improvemenl or other nghFol-way use her?�o 0 '� <br /> � � T� applied for and lurther agrees to remove same upon notice irom Ihe r <br /> Date ublic property damaged thereby. `� <br /> App Qved f��struc � City and to replace p <br /> � �� <br /> ( ��� �� � G� <br /> � t_�� �1�a���'-�- �` .�Y/: � � — <br /> � � r <br /> FIN �NSPECTION Date Late �' <br /> `--�- ignature oi APPIicaN (; <br /> Approved as Constructed <br /> WORK AUTHORIZED BY THIS PERMIT MUST BE STARTGD WITHIN . r, <br /> everett PUBLIC WORKS DEPARTMENT ?80 DAYS OF DATE PERMIT IS ISSUED AND T;iEREAFTER IS TO <br /> � 3200 Cedar Slreet BE DILIGENTLY PURSUED TO COMPLETIO�:. i HIS PERMIT PAAY BE <br /> Everelt,WA 98201 CANCELLED BY THE CITY UPON ANY STGPPAGE GF WORK ON THIS <br /> Phone: 259-8815 PROJECT OVER 50 DAVS DURATION. <br />