Laserfiche WebLink
�"�` v - <br /> �a�Q � / puplic Worke Permll! � /� � <br /> Application For Btap.Daot•_ __ <br /> PlJE3LIC WORICS P�RMI� Pu�TotelFeeFae 5 �,�_ <br /> Lese AOP�Fea PaiE s <br /> 9elanceDua S �'C' � � <br /> Print or Type Only �__ — <br /> �� \ %�^'`� <br /> J-SAACS /�✓C"A)n�I.A1 C �jr,�`i '�� ^ /�cICIP�-� JCb�C� 7 ��^yJ �7/� � <br /> Owner ' Msiling Address City Zip Phone <br /> 'S r�� e, <br /> Ap0licant Mailing Address City Zip Phone <br /> Describe Proposed Work __��C cc� \�-Q Jl <br /> ProjectAddress(if known) /� � 0 � — �.F��� S� � � � <br /> AUach lour(4)copies of plans kr proposed woik- Draw to scale and note the followirg as applicable: � <br /> • Proparry Lines • Centerline of street � <br /> � Outiine and dimensions of all existing and � Inc]icate Ncrih <br /> Proposed structures on the lot • Show any proposed .ading chan�es <br /> a� C_s•sling and proposed utiiities 11 Show measurement:, � <br /> !� DO NOT WRITE BELOW THIS LINE <br /> PERMIT CONUITIONS O <br /> 1. All calls for inspection shall be made 24 hrs in advarce- phone 255-881 5. � <br /> 2. All work shall be performed in accordance with th;s permit and current City of Everett Design and Construction <br /> Standards and Speci(icaticns. <br /> 9. Call Location Underc�round Service 48 hr�. before you dig.TOLL FREE NUMBER 1-800-424•5555. � <br /> � L,� ��pQ.fL,P�'�O ✓J CLC� cY'/ l�MKYlJ � ,i <br /> _ � ( - �� <br /> ��� ������ m �w��� � <br /> (�� V� <br /> � � <br /> z - � � -�� a <br /> 4CKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees tn hold and sav�harm <br /> less the City ol Everett irom any and all claims for damages, wsts, <br /> ��� expenses, or causes of actiun that may �risa because of installation <br /> / / /_� ����,���,� �/,�y and main ance of ihe improvement or other righ4of�way use herr,to <br /> ��'� � � applied I r nd turther agrees to remove same upon notice from the <br /> Ap ved for Construction Date Ciry and o r lace public nroperty damaged thereby. <br /> FINAL INSPLCTIO�V Date " `� —'—^���-��_ <br /> Appwved as Construcled ignaturea Applicant (/ Da�e <br /> everett PUBL!C WORKS DEPAFTMENT WORK AUTHORI2ED BY THIS PERMIT MUST 3E STARTED WITHIN <br /> y � 3200 Cedar Street 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Eve�ett,WA 98201 BE DILIIiENTLY PURSUED TO COMPLETION THIS PERMIT MA`.� B` <br /> Phone: 259-8815 CANCELLED f3Y THE CITY UPON ANY STOPP GE OF WORK ON ThdS <br /> � PROJECT OVER 50 DAYS DURATIuN. <br />