Laserfiche WebLink
i <br /> I <br /> ' I <br /> ��_� PUUhc VJorks Pnrn d � � � <br /> Date /���lC-_/—�., � <br /> Applir,ation For om� ocn�.= _�_1.�L'_c�SS��_-_. . <br /> RUBLIC WORKS PERMIT FubLcWorksFCC - <br /> ,o�,�F��� S— — <br /> �e,za�o� Fe��„� s <br /> o��,���o��� s �c%c--� <br /> Pi�nt or Type Only -_- <br /> � ��� ' _S ►�1����-' A�i.� �-. �i��N-9���5 33�-qC�l�- <br /> Ow er Mailing Address Crty Zip Phone <br /> A�� Mailing Address City Zip Phone <br /> Describe Proposed Work ��� `�1�- � �T y�oS 1.4N �:�J 1 f i "' ,�� <br /> — � <br /> Prolect Address lit known) ��' ���� � - �l-f-�%��'. � S/�- � <br /> Attach four�4)copies of plans lor proposed work- Draw to scale and note the foltowiny as applicable: 1� <br /> • Property Lines • Centerline nf street /� <br /> 4 Outline and dimensions ot all existing and • Indicale 7Jorth W, <br /> proposetl sVucWres on;he lot N Shov+any proposed c�rading changes <br /> • [xistmg and proposed utilities s Show measurements <br /> DO NOT WRITE BELOW THIS LINE � <br /> FERMIT CONDITIONS O �� <br /> �.All calls for inspection shall be made 24 hrs.in advance- phone 259•8810. � ' <br /> 2.All work shall be pertormed in accordance with this permi�and current Ciry of Everelt Design and Construction <br /> S!andards and Speci(ications. <br /> d.Call Location UndergrounC Service 46 hrs before you dig.TOLL FREE NUMBER 1•800•424•555Fi. a <br /> %� i[ �ri c',/�t,i. - i.� , /' . � �� <br /> , y/ ;�..,�/C<.,.� �«.,��:{ �G�(�,/ � .<:�, _ .� r _ O <br /> �. ��2t +[!�ilcLP � i.i=. �C�'Lj2cifs�7/6•v LticGiL/ .P< >t..•� � ;�.� ,-. ,e, <br /> _�n�� .�aC�" (x _c��«..,��r!� b�� .i-�::7� �L�;,. � <br /> -1��:. ,J •a C/�I�.:.,�f,: , . <br /> ��.7iit� �F:G� G.�Cny ���' .-l[`;,. .. . . .�/" �% f/,'. .�;� . _ . -/ .t � . <br /> l� <br /> .� . .. L�.'. �^ . , �.� :i � .�1�''.. . . <br /> . � ' <br /> � <br /> AC4W04'LEDGEMENT OF COIJDIIIONS <br /> The undoisiyneU ownedapplicant he�ehy agrees lo hold and save hann� <br /> �����, I Iess Ihe C��ty ol Everett irom any and all claims for damages. costs. � <br /> �l ��" � � ex enses. or causes ot action ihat ma arise 6ecause of �nstallation <br /> y ��L � / � � � and mainlenance nf the improvement or olhr.r righ�-ol-way use hereto <br /> � � � .f�.� f-n�� �.� /..i ;'7L . <br /> applied lor and furiher agrees lo remove same upon notice from Ihe <br /> Approved for Construc�ion Date Ciry and to replace public propertY dama9ed thereby. <br /> i <br /> FINAL INSPECTION Date � ��/ � y�2�� *� - •� j - h � - <br /> Approved as Consiructed Si9nature ol Apphcant Date <br /> everetl PUBLICWORKSDEPARTIdENT WORK AUTHORI7_ED BY 1'HIS PERMIT MUST 8E STARTED WITHIN <br /> � 3200CedarSlreet 780 DAYS OF DATE RERMIT U ISSUED AND THERE�FTER IS TO <br /> Everett,WA 3820� BE DILIGENTLY PURSUED i�� COMPLETION. THIS PERMIT MAY BE <br /> Phune:259�8810 CANCELL[D BY THE CITY UfUN ANY STOPPAGF OF WORK ON THIS <br /> PROJECT OVER 90 DAYS DURATION. <br />