Laserfiche WebLink
..'..+.. w................ ...�.... ....... e..... .... .«�.. .. . <br />xr� <br />[s1 [s1 <br />A � x <br />9HV+ <br />y�H <br />O x0 <br />'?1 H "i1 <br />yxyCg <br />C�1 O [�1 <br />H C7 <br />H�O <br />�� nCC <br />�Hz <br />h-+ H <br />g.� <br />H <br />CC] C7 f� <br />C�7 � C��1 <br />H O tyi� <br />Date � -� -� � <br />PUBLIC <br />Print or Type Only <br />� �) f� F6E <br />Owner <br />ApPlication Por <br />VVORKS <br />�� ��c?�nrr � �� q� <br />� <br />P '�RMIT <br />O <br />O <br />s oo�;�o <br />� oN�� � <br />�'www� <br />� c� � � �"/�/1� S� G l� <br />Address <br />!� <br />(. L <br />c� [a � � � Z�P <br />W <br />dp~.33 2 <br />PO fi dU <br />I. .� 6 � • c� •. � �. U a • <br />Pu�liC WnrFS Pl�lmil � �L1J� / <br />amq oent+ _ / <br />�/ <br />Pueia Worxs f ec 5 /D2 � <br />To�al Fee l <br />LPSSApDi FcePai� 5---�f-- <br />e�i.,��� o�� 5 /OL � � <br />Zip Nhone <br />Descri6eProposedWork �/r�= i�/��2�C �(�%� i�d��) C�f!!L [�P/tir�2SN�0� <br />Proiect Address Iil known) <br />Attach lour (4) copies ol p�ans for proposed work - Draw to scale antl note the following as applicable: <br />• Property Lines • Centerline of street <br />• Outline and dimensions of all existing and • Indicate North <br />proposed structures on ihe lot • Show any proposed 9�atlinq chanpes <br />• Existing and proposed utilities • Show measuremeNs <br />LINE <br />PERMIT GJNDITIONS <br />i. All calls for inspection shall be made 24 hrs. in advance- phone 259•8810. <br />2. All work shall be pedormed in accordance with this permit and current City of Everett Design and Con�truction <br />Standards and Specifications. <br />3. Call Location Underpround Service 4B hrs. betore you dig. TOLL FREE NUMBER 1•800•424•5555. <br />�/ ��,,. �� y ov� ����'f- z' 2�- 9 0 <br />� <br />PUBLIC N'ORKS DEPARTMENT <br />3200 Cedar Sirnet <br />cvere:t, WA 9B201 <br />Phone:259�8810 <br />Z <br />� <br />�'w <br />_ I <br />� <br />a <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undersigned owner/applicant hereby ac�rees to hold and save harm� <br />less the Cily of Everett irom any and all claims for dama9es, costs, <br />expense5, or Causes CI aCtion �hat may arise 6ecause o� installa�ien <br />and maintenance of the improvement or other ri�ht�of-way use liereto <br />applied for and lurther a9rees lo remove same upon notice irom the <br />Ci�y a Ic rep c,aublic r erty damaged thereby. <br />2 / J�"C� -1�C� <br />gnature ol Applica i Date <br />WORf: AUTHORIZ D 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 BL <br />CANCELLED BV THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OV[R 90 DAVS DURATIOPI. <br />