Laserfiche WebLink
/ '± /� � V <br /> r c`J'7— 9 <br /> ' �e�g aueim Woa�Parmn• � `3 <br /> , Applicntlon For Bnq Depi • <br /> PUBLIC WORKS PERMIT PVtTot�fee�ee � <br /> les��ppl Fee Pue f <br /> Print or Type Only BeisnceDua S �� <br /> � <br /> l'�/ �? lr'r�r��,c ,L' �';9-i� nl srs� F.��� �� �',S .3s�7 jl9S' <br /> Owner Maihng Add�ess Clly Zip Phone <br /> � /,�/�e'v �IQT ,Sn�n� �h AB�ce £vP��y 9p,R1�8 �y�/-3�y� <br /> ApPfl�nnl 'Aailing AdAress City Zip Phone <br /> Describe Proposed Work L-�r9'1/i�/1/0 f�!'�/�11T M/!Yi/Lf9�' lirl .SiY� Q�AA � <br /> 7���, <br /> Prolect AAdreas�if known) ��9- /A�l1 ST �F � <br /> Atlach lour(4)copies ol plens lor proposed work� Draw to scale end note ihe following es applicable: � <br /> • Property Linea • Centerline ol slreet � <br /> • Outline and dimensions ol all PMistiny �nd • Indicete North <br /> proposed sl��cWres on ihe lot • Show any proposad gradine3 chnnges <br /> • Existing and proposod utd�lles • Show measuremr.nls � <br /> Dn NOT WFITE BELOW THIS LINE <br /> PERMIT CONDITIONS O <br /> 1 All calls lor inspectlon shall be mede 24 hrs. m advance� phone 259•88�5. � <br /> 2. All work shell be pa�formed in eccordance with this permit and current Cily of Everett Design and Construcllon <br /> Standerds end Specllicetions. <br /> 3. Cell Locaflon Underground Servica 4B hrs. before yau dig. 'fOLL FREE NUMBEN 1•800•424•5555. � <br /> �/ 9.�f.v 7c5 iyF' �.[FA�F'G �,�r r.�F„� ����o O <br /> f�f�i' .J'n.c s i9n/4�iri.sE, <br /> � <br /> � <br /> O <br /> a <br /> ACKNOWLEDGL'MENT OFC�SNbtYIONS <br /> _ The underslgned owner/apphcent hereby eg�aes b 1 olA end snve harm- <br /> less the City of Everett from eny and all claims for demages, r.osts. <br /> ,�� expensas, or ceuses ol achon thaf may e�ise because ol Inslellahon <br /> �j�` �j �� � und mamtenance ol the imp�ovament or other righbo4wey use herelo <br /> App�oved lor Construt n e�B applled lor entl lurther egrees to �emove seme upon noliCe from the <br /> City and lo�eplece public property demeged Ihereby. <br /> — C-��� ,< - y ('or..�CcZ, , ,��.(�J ���/� � , <br /> FINAI. INSPECTION � Dete « "�`'���� <br /> Approved a5 Construcled Signalure ol Ap licent Date <br /> � WORH AUTHOqIZED BV THIS PEHMIT MUST yE STARTED WITHIN <br /> . PVPfPI� PUBLIC WORKS DEFARTMfNT <br /> � 3200 Cedai Slreel 1B0 DAVS OF DATE PERMIT IS ISSUED AND THEREAFTFP IS TO <br /> Everetl. WA 98201 BE DIJGENTLV PURSUED ?0 COMPLETION. TNIS PERMIT MAV BE <br /> Phone� 259�8815 CANCELLED BY iHE CITV UPON ANY STOPPAGE OF WORN ON THIS <br /> PRWECT OVER 90 DAYS DURATION <br />