Laserfiche WebLink
� <br /> , ; <br /> � i <br />�1.�� � i <br /> r � <br /> I <br /> ; II <br /> �—�CQ � f36—/s��1 <br /> pate � U n��i��wo,ks va�m�� i <br /> AppliwtionFor oia�.oeu�.+_��� �1�. I <br /> PIJi�LIC W�RKS PEE�MIT �����W�,����-_iq¢��t'_ I <br /> �m:,i F�•e 5 -- — <br /> �essnoo�.Fee va�e S <br /> Balancc Due $�•�C''-.'_ <br /> Print or Type Only —__-- <br /> ���' �r��S,j- ���>��. i��,��� �- � « �,r��r �1`.��c�S� ���;�-G3.�5 <br /> Owner ldailing Address Ciry Zip Phone I <br /> ���- <br /> Applicant Mailing Address City Zip Phone <br /> De�cribe Proposed Work _� )I—"K � k )� �' I � �-���(�}�1 �!—�1 Ie _ <br /> Project Address(if known) �.`'/ ��S — �C-'�<��c-�� S�- � <br /> � <br />. Attach lour(4) copies of plars tor proposed work- Draw to scale and note ihe following as applica6le: �r <br /> A Property�ines • Centerline of street ♦� <br /> � s putline and dimensions of all existing an� • Indicate Ncrth V� <br /> ' proposed�tructures on Ihe lot • Show anp proposed grading chanyes <br /> N 6�.isting ano proposed utilities • Show measurements � . <br /> a�.ua�aw <br /> DO NOT bVHITE BELOW THIS LINE � <br /> F'ERMIT COiVDITIONS <br />. 1.All�ali�for inspeclion shall be made 24 hrs.in advance- phone 259•881 U. � <br /> E.;'.II work shali be performed in accordance with this permit and current City ot Everett Design and Construction <br /> Standards and SUecifications. ' <br /> 3.Call location Underoround Service 48 hrs.before you dig.TOLL FREE NUMBER 1-800•424•5555. � � <br /> 4.f-.lul' CFIANGL I IU l HE UI�:I'JEPJAY CUl' i�IUS"f EE AI='F'RC)VED <br /> kY T{-IE F'UF�LIC IJOf;k:S IhISPE:C'7UR. <br /> '� , USE: F'I.IE�LIC DRA1hIA�E SY'`'>TL:_M AS PFOVID6D FOR I)iu,:ip�s-,!:�i�U'1-'-;. � I, <br /> u,. ANY LO"( GF:ADE C:HAMGL=S MUSI" PE AI='FFOVEll E?'� l"NL= I� <br /> F'UEtLIC b10F:f::S IIUSF'EC f011. � <br /> / ' �: .F` (�iTY SThEETS CLEAN (1T Al_L I IMF_S'. � <br /> �� iNSI (al L W(11 �1'� ROnI S 'fCJ Gf �1Dr AT rHE EIID OF f �)i Sl'�,:Lr f;::'.i; <br /> I �i . (IAIi.T '.�L�FF � � f' il:t�l:l S (1'.L �!.)Mf''I._rf�: l � �';UfJ D S.q=� 1 � �j <br /> (�F; f'., I i I" i;.,l '_�,.'., � <br /> � <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The u,�,;ie�si��ned ownerlapplicanl hereby a9rees to hold and save harm� <br /> - less iho City ol Everett fiom any and all claims lor dama9es, costs. <br /> � ,��� � � expenses, or causes of action fhat may arise because ol inslallation <br /> j��."� ��y�,,,�/._ ����ih� and maintenanr.e of the improvement or other nghPo6way use hereto <br /> �ppli[d Inr and lurihcr a�r^es lo iernove same upon nofice (�om Ihe <br /> Approved for Qnstruction Da�e Cdy and to roPl�ce pu�lic proPeiry damaged thereLy. <br /> /����z 5 ,1����� :� - ;� <br /> FINA�VECTION `�� C Date _ — _ <br /> Approved as Crnsiruded S:gnaturc of Applicant Da�e <br /> everell PUBLICWORKSDEPARTMENT V'lORK AUTHORIZED BY TIiIS PL=RGAIT MUST �E STARTED WITHIN <br /> � 3200CedarStreet 1F70 DAYS OF DATE PERMIT IS ISSUED AND Ti1EREAPTER IS TO <br /> 8L� UILIGENTLI' PURSUED TO COMPLETION. THIS PEFMIT MAY B[ <br /> EveretC W�98201 CANCELLED BY THE CITY UPJN ANY STOPPAGE OF WORK ON THIS <br /> Phona 259�A810 pROJ[CT OJFR 90 DAYS DURATION. <br />