Laserfiche WebLink
1 <br /> ,n �,,.,.. ,_ ..._... __ _ ,.;._, __.... . . <br /> �• . . .. . . _ . _ .._ .... ._. . _�.e':- s -:.:,.�; <br /> , _. . . '>' . � . � . <br /> _ ,y, �, . . i::,;.'s :;� <br /> � <br /> �ate��9 P�n�,�w�,ws Pe,m��. B 9- .3y3 <br /> Application For einq Ueo�.• <br /> PUBLIC WORKS PERli111T Puei�cWorwsFen s , <br /> Total Fee <br /> O <br /> � Less no��.Fee V=itl S <br /> O p � <br /> ;, p O Balance�ue $ JS� <br /> Print or Type Only Q o n <br /> � <br /> � ; M on z -32 z-y0_ooa-//-83 / <br /> P <br /> � =^ _ <br /> � /l % — <br /> �/,' �� r� � �� /�- �/1li ,�;'�1���i��if�Crr ���F� � f� � �c, %EJ� � 3�//cElS <br /> Owner Mailing Atldress � � �� �GitY Zip Phone <br /> c� o . � <br /> 0 o f- w <br /> � o .;, x <br /> ; !� :.� m a � c� <br /> �, Applicant Mailing Aadress City 2ip Phone <br /> i <br /> i Describe Proposed Work � ��� � �—� � - � ��•� / ��� ' �, �� <br /> [ <br /> � _ <br /> � <br /> i W �� ��� <br /> � Project Address(if known) �i Z ZO $� �� /'�� � /-;J <br /> � � j� <br /> Attach four(4)copies of plans for proaosed work- Draw to scale and note the following as applicable: � <br /> � � , <br /> . • Property Lines • Centerline of street � <br /> � • Outline and dimansions of all existing and • Indicate North `, <br /> , I�roposed structures on the lot • Show any proposed grading changes . <br /> : � Existing and proposed utilities • Show measuremenis � � � <br /> I <br /> i DO NOT WRITE BELOW THIS LINE O � Y <br /> � PERMIT CONDITIONS V <br /> � i.All calls for inspection shall be made 24 hrs.in advance-phone 259•8810. � � <br /> i 2.All work shail be pedormed i��accordance with ihis permit and current City of Everetl Design and Construction � <br /> ; Standards and Speciticationa . <br /> i 3.Call Location Underground Service 4B hrs.bef xe you din.TOLL FREE NUMBER 1•SOO•424•5555. � i <br /> ' C��a`w2/ �r � � ,d�i .s �U.-�� �.307 � : � <br /> � ti�� <br /> ' �' �/_'%L STANO/J.POI S�C�/Oil/ �.3- 7 � <br /> ' � <br /> � � � <br /> O <br /> � <br /> � ACKNOWLEDGEMENT OF CONDITIONS <br /> � The undersigned ownedapplicant hereby agrees to hola and save harm- <br /> � less the City of Everett from any and all claims for damages, costs, � � <br /> � , expenses, or causes of action that may arise because of installation . <br /> I n and mainten8nce of the improvement or other right-ohway use hereto . <br /> �, applied for and turther agrees to remove same upon notice from the <br /> IApprov r nstruc , Date City and to replace public properry damaged thereby. <br /> / <br /> I � r�� ,2— 7— 9 � / � . <br /> ,( ,� �,. <br /> � FIN INSPECTION Date �� %� � '�`� � � � � i �� <br /> ' Approved as Constructed Signature of Appli ant Date , <br /> i <br /> � everett PUBLIC WORKS DEPARTMEN7 WOFK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> i � 3200CedarSireet 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO � <br /> Everett,WA 98201 BE DILIGENTLY PURSUED TO COMPLETION.THIS PERMIT MAY BE <br /> Phore:259-8810 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAYS DURATION. <br />