Laserfiche WebLink
Date���fJ �� ` <br />Application Fo� <br />PUtLI� WnRKS PERMIT <br />Print or Type Only <br />ownrr <br />' 7�i1 I l� _ _ — <br />� Appllcanl Ma�hn� AdA�ess <br />DNsr.ride Proposed Work _ <br />i=,�.i���wn�..v.,,�n Oa/ "/"S <br />flvt f • .'�(����'I <br />i <br />,�,�.� w, ;1�1d� . 1 ��.�.x4 <br />,�,a, �.: � _ <br />� ".. nnni v.r cn�n S __. <br />m:a,.., � n„- S. e� O-�_ __ <br />Cny Zip Phone <br />� <br />Pro�ect Adtlresslif known) �2�0 �tR — �l%-j r�f�-,SW. ---- <br />Avach lour 141 copies of plans Im propoaeA work - Drew lo scair anA note the lollowinp es xpUhr,alil�• <br />• Property Linee <br />• OWline and dimensions of all r+islmy and <br />�roposed sl�uclures on ihe lot <br />• Eaisl�ny xrv1 proposed ulildies <br />• Cnnterhne ol strePl <br />• InA¢ale Norlh <br />• ShOw Pny propo5rd �7r,�dinq rhany��5 <br />• ShOw mP05urement5 <br />PERMIT CONDITIONS <br />1. All calis lor Inaprchon shell ba mede 24 hra. in Ndvance � phone 259•88i0 <br />2, All work shell be pedormed In accordance wilh Ihis permit anA current Cily ol Fverett Desi9n anA Conslruclion <br />Stenderda and Specilicetione <br />3. Call Locntion Undergmuntl Servlca 48 hrs. belare yau dip TOLI FREE NUMBER i•8�•4Z4•55SS. <br />T f1��V� f�/A2'C6 /N T//� %%E'/v�Scc�i�J/ Lc�cATi!'N /lj�:st <br />d�� �Iv�.cov�o By ''./E P�ih'u� c�Jo,�,t�s .J-vS';��, r�%'. <br />S�f-,�s- e. ry s,-,e�-E-rs ��,-: �.�/ �r /'« ; ��,-, a= _r <br />�_, �� /' n�o� ,3 ry .�s <br />ApPro lor Consll.ir.lmn Dale <br />,� � �� /� '/ S / <br />iNA.INSPE QN����� ������ete <br />Apprpved N5 Gon9lruc�@A <br />rvrrell PUBLICWOFKSD[PApTMENT <br />� 3200 Cetlar Streel <br />Everell, WA 98201 <br />Phnne 259�8810 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />W <br />� <br />� <br />The untlers�aned uwneUapplir,anl hcreby agrees to hnld and save harm <br />less ihe Cdy d Everelt irom eny anA all r,lalms lor tlamnpes, cosis <br />eepenses. o� cnuses of action that may erise because ol inslallatio�� <br />and mninlenance ol Ihe �mprovemen� or cfhe� n�hl-o�-wey use herr.to <br />a phed lor and lurther a9rees lo remove same upon notice irom Ihr <br />C�y entl to repl;fr.e pu�hc property tlanaged Iheieby <br />/.' ��1 ,� � / <br />� �' ���1.. � � �i t'� <br />Signa ure o� APP���enl Da1e <br />WORK AUTHON17ED BV THIS FERMIT MUST 9E STARTED WITHIN <br />180 DAVS OF DATF PERMIT IS ISSUFD AND 1HFREAFTER IS TO <br />BE DIUGENTLV PURSUFG TO COMPLETION THIS PERMIT MAV BE <br />CANCELLED BV THE CITV UPON ANY STOPPAGE bF WORK ON THIS <br />PROJ[CT OVFR q0 DFVS DURAT�ON <br />