Laserfiche WebLink
Gub�it Works Parmit• � �/ <br /> �BtB/� �G� aiaa.oeo�.r <br /> Applicatlon For <br /> PUBLIC WORKS PERMIT Publ¢Wor4Faa ,_ — <br /> Tol�l Fae <br /> Lass��0�Fsa PaiA = � ^0 0 <br /> Belanca Due <br /> s J^V -� <br /> Print or Type Only pOZ-3ZZ�0/��� <br /> ��, ��G .l.l. �a o � ��% �"� � <br /> OW�� MeiNng Address <br /> Ciiy ZiP Phone <br /> ? ��,��9 /xu�/��9��7� ����sAys' <br /> �n�� � Q Z�p Phone <br /> � Mailmg Address City <br /> � APPlicant <br /> • � � / r., <br /> � <br /> . Describe Proposed Work �s� n U � S <br /> � � <br /> V <br /> ' ` f � ✓ n c�l^a� �"A � <br /> 4 � <br /> �_ 3k- _ � �ao3 � <br /> Prolect Addreas(if known) � � <br /> . Attach four(4)copiea of plens for proposed work- Draw to scale and note�Ce�Iterline of tPeet able: � <br /> • Property Lines � Indicate Norih <br /> ' � Outline and dimensions ot ell existing and � Show any proposed grading changes � <br /> proposed structures on the lot � ghow measurements <br /> ' • Exiating and proposed utlli�ies <br /> , DO NOT WRITE BELOW THIS L�NE O <br /> PERMITCONDITIONS � . <br /> �, 1.All cella fa inspectbn ahall be made 24 hrs.ia edvence•phone 259�8810. <br /> 2.All work ahall be peAarmed��8�°�^ce with this permil and current City ot Everett Deaign end Constructlon � <br /> � Stendarda and Specificaliona. <br /> � 3.Call Locatlon Underground Service 48 hrs.be�ore you dig.TOLL FREE NUMBER 1-800�4245555. <br /> � /1'/ � .L L O <br /> I /' �.G�� G�fY ,S//'�EtJ C��C4i� af G�� 7iM�s �. <br /> � ,s DO HO/ COl/C�"' D/" G�Irr+G1TC Lc/QfZ'� .S��SfPM !�a dC� � <br /> I • U � <br /> pi^ S�Z�✓c'r /nGn/fole. <br /> � 6 . �4✓7 O'lYeino' G G✓a� SO /'4�ntda72r' Lon'1inu�S /6 O . <br /> O�/'oi� to SfYeef" CcfC�� ��S/n • a <br /> ' ACKNOWLEDGEMENT OF CONDITIONS <br /> i <br /> � The undersigned owner/epplicant hereby agrees to ho!d and save arm- <br /> ' less the Gity of Everelt irom any and all cleims for damages, costs, <br /> expenses, or causes ot action that m<.y arise because ot installation <br /> � , �� and mainte�ance o�„i1e �gre sVto emov�, ame upon not cestromrthe <br /> i (, a B 3 applied lor ��nd ub�i P��PB d aged thereby. <br /> ate CiIY nd to r a P <br /> qpprwed for Construction <br /> ��1�� s-�� - 9y' /° <br /> ate Date <br /> FINAL INSPECTION gig re Appl' ant <br /> � qpprovod as Constructed WORK A HOR ED BY T IS PERMIT MUST BE STAR ED WITHIN <br /> � PUBLIC WORKSDEPARTMENT BE DI�LIYENTLY PURSUED TOICOMPLETION.DTH SEPERMIT MAY E �' <br /> 3200 Cedar Street CANCE LED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Everett,WA982U1 pROJECT OVER 90 DAYS DURATION. <br /> Phone:25&8870 <br />