Laserfiche WebLink
� <br /> � <br /> '� <br /> i �< <br /> j �� <br /> H <br /> �' <br /> ,._ . . i <br /> oac�:�� P�,�,���W��ksPe,m�. �`�/—GD <br /> AppliCation For dinn ocai.• ��"�(,SC_!S._.J . <br /> PUBLIC WORKS PERIlIIIT �°°b�,°,��°«sF�� <br /> iotal Fee g_ <br /> Less ApPI F¢e PaiJ ��_ <br /> Print or Type Only �'"��`•o�� � - � = <br /> .�l�i , �`'S � �/'�Sf"I� j��« � '�i i /�aJ/)'l�a-I� J�ll f�,l ��a7� <br /> Owner Mailing Address Gty 2ip Phone <br /> .�.—����1�-� I, � � ,�!�� ���`-�'�� <br /> AppGcant Mailing Addrr.ss Ci� Lp Phone � <br /> DescriGe ProPosed Work ��F-- /I J* J� ����1��� ( �('," ) i ��. <br /> i <br /> / ��S' � �� '_ � I� <br /> Prolect Address(if known) _. `�-' •�I��c�. ('�''. __ - � <br /> Attach four�4) copies of plans tor proposed work- Draw to scale and note Ihe following as applicable: � <br /> • Property Lines • Centerline of sireet � <br /> • Outline and dimensions ol all existing and • Indicate Norih <br /> proposed slructures on the lol • Show any pwposed orading changes � <br /> • Exis�ing and proposed utilities • Show measuremenis � <br /> DO NOT WRITF BELOW TNIS LIME <br /> PERMIT CONDITIONS O <br /> 1.All calls for inspectiun shall be mace 24 hrs.in advanc�• phone 259•8810. � <br /> � 2.All work shall be pedormed in accordance with this permit and current Ciry o(Everett Design and Construction <br /> Standards and Specilications. <br /> 3.Call Location Underground Service 48 hrs.beforc you dig.TOLL FREE NUMBER 1•$00-424-5555. � <br /> O I <br /> �w <br /> �/ <br /> O <br /> � I <br /> ACIWOWL[DG[MENT OP CONDIiIONS <br /> �� The undersigned owner/apphcant herehy aqrees to hold and save harm- <br /> — less the City of Everett from any and all claims lor damages, costs, <br /> /, , expenses, or causes of action iha� may arise because of inslallation <br /> i� �-,� : and maintenance of the improvement or other right-of-way use hereto i <br /> �l�'� �- .��•c /'� _ �.r ,, <br /> � � applied for and lurther ac�rees to remo�ie same upon nutice Irom the <br /> Approved for Con�ction % ate City and to replace pubhc properry damaged ihereby. j <br /> `� /� �_�-f,� —� _ . <br /> G= <br /> FINAL INSFECTICN Date `�- '�'�-- 3�.:��— <br /> Approved as Conslructed Signa i I Applieant Date� <br /> everell PUBLICWORKSDEPARTMENT WORK AUTHORIZEC BY THIS PERMIT MUST BE STARTED WITHIN <br /> � 3200CedarSlreet 180 DAYS OF DATE PERMIT IS ISSUcD AND THEREAFTER �S TO <br /> Everett,WA98201 BE DIUGENTLY PURSUED TO COMP�ETION. THIS PERM19IT PdAY BE <br /> Phone:259�8810 CANCELLED BY THF CITY UPOIJ ANY STOPPAGE OF WORK ON THIS <br /> IPFOJECT UVER 90 UAYS DUFATION. <br /> � <br />