Laserfiche WebLink
� � <br />Date �"��', <br />�pplication For <br />PUiBL.IC WURR�� QERi�1T <br />Print or Type Only <br />/LGlS ���1� �v� �aG• S�" <br />Owner MaJing Addi <br />Applicanl <br />Address <br />.��y /`"7 <br />PubLc WorMs Permu U --- -- <br />eme. o�o�. . �/ 3 3 �� �= <br />Pub�ic Works Fo5 y, �–Q .� <br />Tolul Fao <br />Loss Appl Foo Pnitl S--�� <br />Baianca Duo <br />$ a��'��=�� <br />1r7 <br />Zip <br />City Zip <br />� �yy� <br />��ss-�/yi� 2.. <br />Phone <br />Phone <br />p=scribe Proposed Work <br />/,�%5/fle� �� li'�-' �C'i✓r PF7F c�,Q�Uc7ve�Y — <br />Projecl Address (if known) <br />1"� �f. 1.�. <br />Attach tour (4) copies of plans tor proposed worh - Draw to scaln and note the following as applicaUle: <br />• Property Lines <br />• Outline and dimensions of all exisling and <br />proposed structures on lhe lot <br />• Existing and proposed utilities <br />! Centerline ot street <br />o Indicate Norih <br />• Show any proposed 9rading changes <br />O Show measurements <br />PER641T CONDITIONS <br />1. All calls tur inspec�ion shall be made 24 hrs. in advance - phone 259'8f�� 5� <br />2. All work shall be performed in accordance wiih this permit and current City o' Everett Desic�n ond Construction <br />Standards and Speci�ications. <br />3. Call Localion Untler9round Scrvice 48 hrs. tefnre you dig. �TOLI FREE NUfNdER 1•Sn0-42�i�•JS . <br />ACKNOWLEDGEMENT OF CONDITIONS <br />•f � <br />�' <br />°� <br />i <br />The undersigued owner/applicant hereby agrees W hold and save harm- <br />-- Ie,s the G�,ty of Everetl from any and all claims for damages, costs. <br />�i e.zpenses, or causes of action ihat may arise becau;e of installation <br />i n/ / � I and maintenance ot the improvement or olher righbohway use herelu <br />/`��' S -�� ��� applied for aod (urlher agrees to remove same upo�. notice trom the <br />� " , Date� CitvsrdltY replace pyblic property damaged thereb��. <br />r <br />Date <br />FINALINSPECIiuN � � <br />ApProved as Constructed <br />evere[t PUBLIC WORKS DEPARTIdENT <br />� 3200 Cedar Street <br />Everett, WA 98201 <br />Phonc:259-8815 <br />Cc' <br />c�= <br />,__� /�`. <br />S�"i"g1� ture ci APPIi nt <br />" Date <br />v�RK AUTHORIZED 6Y THIS PERMIT MUST BE STARTED WITHIN <br />i80 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS FERMIT h:AY BE <br />CANCELLED BY THE GTY UPON ANY STOPPAGF UF WGRK ON THIS <br />PROJECT OVER 90 Dl1YS DURATION. <br />z <br />c <br />�-i <br />n <br />�� <br />�, �. <br />—{ T <br />r.r y <br />V1 S <br />0 <br />m <br />co <br />mo <br />-{ c <br />03 <br />m <br />-i z <br />S —I <br />m <br />� � <br />c` <br />a —+ <br />r x <br />�. .- <br />--I N <br />� <br />�l <br />O A <br />-n n <br />-i f*i <br />x <br />m� <br />:n <br />v <br />or <br />c� r� <br />c tn <br />3 (/� <br />m <br />z c� <br />-1 r <br />. m <br />a <br />A <br />z <br />v <br />� <br />� <br />m <br />