Laserfiche WebLink
._ r�. <br /> � <br /> � I <br /> W y � <br /> �� � . ., <br /> ��,� ----- <br /> ��'1� I � ` � � Pu01iL WOtF9 Palmi�• <br /> W Date eioe oeo� . _�o, 1 YG/r <br /> �SS� I Application For �I <br /> o� ! PUBLIC WORKS PERMIT PUUToaiFec�ee � <br /> ��� I Less 400��Fee Pai� g � <br /> QNr BalanceDue $ I <br /> s y� Print or Type Only <br /> t� <br /> �Ny <br /> � >'a iS�c� .re E-uT 5sz� ? 3.��-s'aoa <br /> g�y I hrAGsr�� D��r.v� ��r i� : , <br /> � r 6voMrTi-w--� Mading Add�zss Ci�Y LP Phone � <br /> '�y I� � � �• o i�--� G c s�r' .�E a�e i� ,Qi�z7'� g P�sT v E'r-s 7 � � <br />� - - — Applicant Mailing Address Ciry 2 P Phone <br /> I <br /> - " I Describe Pwposed Work � <br /> _ I <br /> � � I <br /> S [� <br /> Project Address Id knr,wnl /0 �3� ' �9'�� �'vE — � <br /> Atlach lour(4)copies of plans for proposed work-Draw to scale and note the lollowing as app��cable: � , <br /> - • Property Lines • Geotedine of sireet � �� <br /> ! • Ou�line and dimensions o�all exis�ing and • Indica�e Norih I <br /> proposed slrucWres on the lot • Show any proposed grading changes I <br /> • Ezisting and pw0osed utilities • SYow measurements /� . <br /> I I �j DO NOT WRITE BELOW THIS LINE W , �' <br /> 1�' ! PERMITCONDITIONS O <br /> '�' i 7.All calls for inspection shall be mede 24 hrs.in advance-phone 259•8810. � i <br /> 2.All work shall be peAormed in accor�ance with lhis permit and current Cily of Everett Design and�onsiruction <br />� 1_' i Slandards and Specifications. <br /> 3.Call Location Underground Service 48 hrs.belore you aig.TOLL FREE NUMBER 1•800•424•5555. �) I <br />� � (' �— Ll L�v0121GS ��1 �G2�J 1 Ir�l' O ' <br /> ' I <br /> ' ��t. Nl�- ~ <br /> �� I '�-ZZ-90 '/� � <br /> I j ---� O <br /> 1' ' <br /> -� a <br /> _ � <br /> � � <br /> ' i ACKNOWLEDGE"4ENT OF CONDITIONS <br /> The undersigned owner/applicart hereby agrees to hold and save harm- . <br /> �-�— �� less the City ot EvereU lrom aiW and all claims for damages. costs. <br /> � expenses. or causes ol action lhat may arise because ol installation I <br /> �, and maintenance oi the improvement or othe< <�9h1-o(�way use hereto <br /> applied for and lurther ac�rees lo remove same upon notice ��om Ihe <br /> Approved lor Construction Date City and to repiace public prope�ty tlamaged Ihereby. <br /> FINAL INSPECTION Dale Date <br /> 4pproved as Consiructe^ Signature of APPliwnt <br /> WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN I <br /> everett PUBLICWORKSDEPARTMENT 1g0 DAYS OF DATE PERMI7 IS ISSUED AND THEREAFTER IS TO <br /> � 3200Cedar5lreet BE OILIGENTLY PURSUED TO COMPLETION. THIS PEPMI7 MAV BE I <br /> Everet6 WA98201 CANCELLED BY THE CITY UPON ANV STOPPAGE O�WORK ON THIS I <br /> Phone:259-8810 PROJECT OVER 90 DAYS DURATON. � <br />