Laserfiche WebLink
—---�� <br /> � � � <br /> ay <br /> C, � H <br /> 9H [n <br /> tx9 <br /> yz ��-+ <br /> FC c) <br /> O x O � ��� �p� � ^ <br /> 'TJ H � Date�l�.:iil a�ei�c w�,es r���,n= C�d— J'G <br /> [p H <br /> y r i � eiee oeni ,—�_7 �� Z 5__ " <br /> � y � Applicalion For -- <br /> Pl16LIC WORKS PERMtT P°°��°°�°.�=°�a <br /> ,a���.�� s <br /> HC�T1 <br /> g LesSApo� PoCPauf 5�� <br /> �� n e.,i,�,�„o�� s 55�5/ <br /> 9 y � Print or Type Only <br /> t� z <br /> t-� H <br /> otyv� ?.F-12 /-�s3nc r�P� 142 °i �rr_,t,r:� , �n .i F_ ve/v/�- I�Ui`}- ��zvl Zb2 - / / EL� <br /> Owner Mading Adtlress Gty Zip Phone <br /> L�7 � C�] <br /> zy �n Sq� z <br /> y � y Applicant �dailinp Address City Zip Phone <br /> DescribeProposedWork S� kLp� �n�S�r� � %l�nc�e <br /> � <br /> ProjectAddress(ifknown) _Zyn2— �.�Yh�7" � <br /> Attach four(4)copies of plans for proposed work� Draw to scale antl note the tollowing as applicahte: � <br /> O Property Lines • Centerline oi sVeet /A <br /> • Outline and dimensions ol all existing and • Indicate Norih V� <br /> proposed structures on the lot • Shov+any proposed rwdin9 r,hanyes <br /> • Existing and proposetl utilities • Show measurement�, �p <br /> f�' wia <br /> ' ' UO NOT WRITc BELON'THIS LINc � <br /> � PERMIT CONDITIONS <br /> ��' i.All calls for inspection shall be made 24 hrs.in advanc�-phone 259•8810. � <br /> 2.All work shall be pertormed in accurriancz wilh this permit and curren!City ol Everett Desi9n and Construction <br /> � � Standards and Specilicalions. <br /> � 3.Call Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBFA 1•800•424•5555. � <br /> �-� � - -� -- , ._- <br /> - � � ,� � <br /> ��� ��,i / G 1}'c /l, L���i-<--.�_��> ,:�' -�-1 <br /> '�' �/°��U��%� �G�17/J�_c��i''�Z� `\ <br /> � /� ' � <br /> � - %L�1�� " / G=�`_ <br /> �� S �$���' �/�/��"'=�i�'-/� ✓ i p <br /> - � _, ,,, ;, � -�r- �- - � 3 -z�' l � �� � <br /> .. �.'��-�, �v�'-<� �.i� � <br /> 's' � <br /> Iv� <br /> ' ACKNOWL[DGEMENT OF CONDITIONS <br /> - The unde�signed owncUapplicant hereby agrees to hold and savc harm- <br /> - �-- — — less �he City ol Evr.ret� irom any and all claims lor d,'�mayes. cosis. <br /> expenses, or cnuses of aclion that may arise because of installaiion <br /> ���-- ��� � �/�,-� and maintenance ot lhe improvement or n�her righ�-obway use herelc <br /> applietl for and furlh.ar a�rees to remove same upon notice �rom R,e <br /> npp o�ed for Cortsir" . � n ,� . � '� City and to reolace uuolic property dama9ed thereby. <br /> �,/.���� � / <br /> + <br /> ���J` �'� //- / -d=F / � ' ., �. <br /> ; ;.- ��, <br /> FINAL INSp CTION Date � � <br /> Approved as Constructed SignaWre ol AUPlicant ^� ���� <br /> WORK AUTHORIZED BY THIS PERMIT MUST 9E STARTED WITHiN <br /> everett PUBLIC WORKS DEPARTMENT 180 DAYS OF JATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � 32JOCedarSireet BE DIUGENTLI' PURSUED 10 COMPLETION. THIS PERIAIT t.;AY GG <br /> Everel�,6Vl�,98201 CANCELLED 8`!THF GT1'UPON ANY STOPPAGE OF 1NORK ON THIS <br /> Phone:259�6010 PROJ[GT OVEF 00 DAVS DURATION. <br />