Laserfiche WebLink
Date. L Nell WPMPermPe <br />l ass DeP� • �.l� /_— <br />Ann ralmn ro, <br />H PUBLIC V.Fee <br />LosAll FORKS PERMIT rom¢W FFee <br />, <br />y n y e — <br />L5*1'lL•i+ PPi Fee Peas ^^ <br />p.x ePMnre No <br />y y Print or Type Only <br />H �3 <br />/0 7l ed a�o <br />O� H wner Malling Address Cdy Lp Phone <br />y H <br />y z GML <br />H t7 Applicant Mailing Address City <br />Phone <br />� p.i�y <br />7Htl M Describe Proposed Work <br />all O <br />ZH <br />r tiI —_ \Mork ,,.Iick <br />a�li Ga,dl J-l- <br />t•, Project Address of known) <br />z y y Attach four (4) copies of plans for proposed work • Draw to scale and note the following as ola <br />y O EA Properly Lines • Centedme of sir, <br />• Outline and dimensions of all existing and • Indicate North 1 / <br />proposed elruclures on the lot <br />• Show any propol <br />• Existing and proposed utilities •Show measureml Z 0 `'L <br />DO NOT WRITE BELOW THIS LINE <br />I` PERMIT CONDITIONS <br />I.All calls for Inspection shall be made 24 fire 'n advance • phone 259.8810. !!! <br />2. All work shag be performed in accordance with this permit and current City of EVBA <br />Standards and Specifications. 10 <br />3. Call Location Underground Service 48 his, before you dig. TOLL FREE NUMBER <br />tares <br />4#' Gail/).- . z%OAF d F:�<C To A <br />aF G" . <br />�� S, �[//J1E2 S,eR✓^Cd TG flE' .iic%T�'hL`'U ri /Ii l'k, <br />�_I � 0 <br />f <br />'`' <br />earl <br />— <br />ACKNOWLEDGEMENT OF CONDITIONS <br />sees sese, <br />'sell sell <br />iq iprnVCd for Construction Date <br />I INAL INSPECTION Date <br />/,,,proved as Constructed <br />W <br />PUBLIC WORKS DEPARTMENT <br />0200 Stroall <br />Everett,tt. WA WA 98201201 <br />Phone: 259.8810 <br />The undersigned ownerlapplicanl hereby agrees to hold and save harm. <br />less the City of Everett from any and all claims lot damages. costs. <br />expenses. or c9uses of action that may arise because of Installation <br />and maintenance of the improvement or other right-of-way use hereto <br />applied for and furlh r agrees to remove same upon notice Irom the <br />City e4repla7c4ublic properly a aged thereby. <br />zSignat Date <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION, THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION, <br />