Laserfiche WebLink
Uate1�1�� � <br />qpplicalion For <br />Rl1 VLIC •.O! O�tV ■ ��3�II� <br />Print or Type Only <br />C. c�'c�='c�1 /I;i� <br />Mailin9 Address <br />Cwne r <br />QW/+�'�;r <br />Applicant Mai� <br />Address <br />cnv <br />Describe ProPoseA �`lork I�%ST�tL '��/ �/�"� �L9/'x��7� ���Cu�ll�� <br />Pu�lic WaiW Peimil � ��—�—�� — <br />eiaa. oeoi. • AS�I /'�� _i 5� -- <br />PUCIicWo�keFnn g--__._ <br />Tow�Fee <br />Less AO�I. Fea. ('a'd $ ��—J�—��---- <br />Balance �ue S —�<'=—�` <br />��505 <br />01 .3s's -yys�a - <br />P;olect Address (if known) ll'/_, `�—" �-- <br />At.ach four (4) copies ol plans for proposed work - D�aw to scale and note the tollowing as applicable: <br />p Property Lines <br />• Outlir�e and dimensions ot all existing and <br />proposed structurr,s on the lo� <br />9 Existing and proposed uliliF •s <br />��C,yQie�ar ���me <br />• Centerline of street <br />• Indicate North <br />• Show any proPosed 9rading changes <br />• Show measurements <br />PERMIT CONDITIONS <br />t. A:I calls tor inspection shall be made 24 hrs. in advance - pnone 259-881 5. <br />2. All �Nork shall be performed in accc•rdance with this permit and current City of Everett Design and Construcrcn <br />51an�fards and Specilications. <br />3. Call Loca�ion Underground Servi:e 48 hrs. belore you dig. TOLL FR'cE NUMBER 1'800•424-55 . <br />for <br />j -(/ <br />FINAL INSPtcu�rv � � <br />ppproved as Constructed <br />evcrett PUBUC WORK� ��ARTME <br />� 3200 Cedar Str� <br />Everelt, WA 98201 <br />� Phone'259�6815 <br />�:, <br />ACKNOWLEDGEMENT OP GONDITIONS <br />The ur�dersigned owner/applicant iierehy agrees to hold and save harm� <br />less the GitY of Everetl irom am� and all claims lor damages, costs, <br />expenses, or causes ot action that may arise because of inslallation <br />and maintenance of lhe improvement or other righl-ot�way use hereto <br />ypplietl lor and (urther agrees to remove same upon notice from the <br />�i�y ;�� replace pub�ic proPerty damaged thereby. <br />-; , �, j <br />�� c <br />� v'��'" / Date <br />grQ � re ol Applican <br />W RK AUTHORIZED BY THIS PEAMIT MUST BE. STARTED WITHIN <br />80 DAYS OF DATE PERAAIi IS ISSUED AND THEREAF7ER IS TO <br />BE DILIGENTLY PURSUED l0 COMFLEiION. THIS PERMIT MA'I 6E <br />CANGELLED BY -fHE CITY UFOK PNY STOPPhGE OF WORK ON T111S <br />pROJECT OVE:a 5�i DAYS �URATION. <br />ti �. <br />� � <br />� r <br />C7 <br />O� <br />r <br />�'� <br />M <br />r� F <br />� <br />i–i �- <br />� �_ <br />O <br />rr . <br />yr <br />�: <br />�. <br />ti: <br />