Laserfiche WebLink
�,. . <br /> Date�l"p� PuplicWo�kSP�rmils _ �V / <br /> Application For Binq Dept , _�g,__/9 '(�___ <br /> PUBLIC VIAfJR�C� PE'�IIAi��' PuliicWorksFeo — <br /> .o������� �_ <br /> Lees ApnL Fac Fai� S�l�� <br /> Print or Type Only "'""-=c°`—5 � _ <br /> �QhGP � LOhSTYUc77o� P�, Thc_� o%S�- 2y���sf el/i�a� yr1��- G7/-9i ;�� <br /> Owner M3ifny Address City ip ��hone <br /> SQM L <br /> Applicant Mailing Address City Zip Phone <br /> Describe Proposed V`�ork �/���I��J�i.cidCy! � <br /> LO f �� GYSPh �ahfC <br /> — — �n - i�Y <br /> Projecl Address(if known) _ �D7/2 — IO --.D.E', S,_.L � <br /> 0 <br /> Attach lour(4) coGies of plans for proposed work- Draw to scale and oote the following as anplicable: �� <br /> • Property Lines • Centerline ol street �w <br /> • Outline and dimensions of all existing and O Indica�e Norih �� <br /> proposed s�rucWr� s on �he lot • Shov;any proposed grading chanyes <br /> • Existing and propa.;=d utilities • Show measurements � <br /> ���1��Y'�l�VTi��I R�o <br /> DG NOf WRITE 6�Lq4S'THIS LINE � <br /> PERMIT CONDITIOr;S <br /> i.All calls for inspect.�r ,,�all be made 24 hrs.m advance-phone 259-8£i�0. � <br /> 2.All work shall be pe�Iormed in accordance with this permit and current Ciiy o(Evere!t Des::�.�and Gonstr�ction �-- <br /> Standards and Specilications. � <br /> 3.Call Location Underc�round Service 4d hrs.belore you dig.TOLI FREE NUMBER 1-800•E�2��•SSS.ri. S � <br /> G <br /> r H� � - .- ' i :i: � � . ci� � :�J i � . � � <br /> ; 711� ! U��L 1L l�J(]P21 5 � I',1=' r rOF�n <br /> �F I<•�IELT.C: L�F;AII�iAfiF S'r-;TEI" .lti f'R04'1:pFI) ,=0ct � <br /> � <br /> _.QT GRPfiF= CHi=�fJG'L S I iU:� l' I3E �>Nf R , � <br /> _ �r:; l4Clh'.I':S i.l•JSI='!:iC l'lF'. � <br /> C:I1'Y c"fREGiS CL.FFiId r'�l !`,LL. -' 7 �•'- � <br /> � I � . _ � ..� .. _. �.. . . . . . . . . . <br /> . - ., .. , ..:. ;�: .�� . . . . <br /> � /{'JA�.� Sc�iz� p.c'ivt_=tu9,ys .9.�zr COin.��ErEc.f/ Gc,2�1� <br /> ,j�,E`U/'•� �i�'iliiiL�C+ !lN TN��- ACKNOWLEDGEMENT OF COI.DITIONS <br /> The undersigned owner/applicant hereby agrees to hold and save harm- <br /> less Ihe City ot Everett Irom any and all claims for damages, costs, <br /> expenses, or causes of aclion �hat may arise bec3use of installation <br /> ( /��.��� � G � and mainlenance ol �he improvement or other righ�-ol�way use heretc <br /> �UG ����"'� _O �pplied lor and further agrees (o �emove same upon notice from ttie <br /> App�ov�or Con;truction / a� City and to replace public properiy dama9ed thereby. <br /> _—� ��"�z�� � �/3 k'S� —� /o/ , �r^�(�� <br /> FINAI_�PECTION Date ��/y���� �'��-�X_ <br /> Appreved as Constructed Signature ol Applicant �`!--�%1 Date — <br /> �•vere[t PUBLICWORKSDEPARTMENT WORK AUTHORILE� E?Y THIS PERMIT MUST BE ;TARTEO WITHIN �� <br /> � 3200CedarStreet I 180 DAYS OF DATF PeRIdIT IS ISSUED AND THEREAFTER IS 70 � <br /> Everett.WA98201 BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY B[ <br /> Phona 259-R810 � CANCELLED RY l HE CITY UPON AMY STOPPAGF "F WORK ON THIS <br /> � PFOJECT OVE�i 9D DAYS DUR�TION. <br />