Laserfiche WebLink
rrr---���//�� �l ) � �� <br /> �+� I � I Publ.c\YorksPc�mila � �_�.`'-J <br /> Date � <br /> ` B�tlJ.�epL� � <br /> Appiica�.lon For <br /> PIJBLI� Vl/t)piC� ��F�I� IT auotomFa�FeC S <br /> Less Pppl.Poe Pe�� S <br /> �/,�— <br /> 3alancu Due $_•- � ��— <br /> Print or Type Only <br /> F_(I-�'��l Il/.�;1� ,%Y� R��'.S�<<� �.� t���� `��C� �-��7-,��'o�� <br /> Owner Mailing Address Gty Zip Phone <br /> I X (,Il��::� ��7 SE � �rr � NI�1l I'� "� � ��-�c-��z')!� <br /> p.pplicant Mailing Address City Zip Phone <br /> Describe Proposed Work _Y��!A� �" <br /> � <br /> Project Address(if known) <br /> O `J�/�— �L� �/�iF; S E COT�'<9^ O/`'/Y7T /:rld ��_ H <br /> Atlach four(4) copies o( plans for proposed woik- Draw to scale and note the toilowing as applicable: � � <br /> s Property Lines . • Centerline of street � <br /> • Outline and dimensions of all existiny and • Indicate North <br /> proposed structures on the lot • Show any proposed grading changes � <br /> • Existing and proposed utilities • Show measurements � I <br /> DO NOT WRITE BELOW THIS LINE o I <br /> PERMIT CONDITIONS � <br /> 1. All calls for inspection shall be made 24 '�rs. in advance- plione 259-881 5. � � <br /> 2. All work shall be performed in accor(ance with this permit and current City of Everett Design ami ConsV�ation <br /> Standards and Specifications. <br /> 3. Call Location Underground Service 48 hrs. betor�you dig.TOLL FREE NUVIBER 1•800-424-5555. � <br /> ^ /� ���� � /fl_�, <br /> �����OZ c�L2;oL.�'Ef-ch<'.(�✓ CL�r��1 Cv��-� -�fi-c,?�� � <br /> �L �� �' <br /> , ��., l�:��-��'--�- <br /> ���L u � � <br /> v w <br /> �A I <br /> V <br /> a <br /> �, <br /> NCKNOWLEDGEMENT OF CONDITiONS <br /> The undersiyned owner/applir:ant her2by agrees to hold and save harm- <br /> less the City of Everett from any and all claims for damages, costs, <br /> //_ /� ,� // � expenses, or causes ot action thal may arise because of installation <br /> /' r' 7 � and maintenance of the impmvement or other righl�of-way use nereto <br /> ��'- ����L�" ^ /�j�� apP��ed br and turther agre�es to :emove same upon notice from the <br /> Approved for Con � n Date City and to replace public p'operty damaged thereby. <br /> � 7��h�8 • -� . <br /> „ ,� • <br /> FItJAL INSPECT{�N Date ��—"�� � �' `��� �> ' ��� <br /> Approved as Constructed ��nature of Applicant / Date <br /> everett PUBLIC WORKS DEPAF7YIENT WV�K AUTHORIZE dY THIS PERMI MUST BE STARTED �NiTHIN <br /> �� 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> 3200 Cedar Street OE DILIGENTLY PURSUED TO COMPLETION.THIS PE,^,;+iiT iv1,0Y BE <br /> Everetl,WA 98201 CANCELLED BY THE CffY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone: 259-II815 pFOJECT OVER 90 DA'iS DURATION. <br />