Laserfiche WebLink
____- �._ _ <br /> Date�[f�� ��3i/ <br /> Pu�Lc WorMs Permlt• <br /> Application For emo�oso�.• <br /> PUBLIC WORKS PERMIT PV�ToteFee�c� : i�� <br /> . Lesa�pol Fee Peia S�S_ <br /> Print or Type Only ea�ence Dce f '��7�� <br /> �52-5/G/ <br /> it/i�. �� /s %.�4s1 ��D<o 33�`C� cr�.rKF � w.a `1��U/ <br /> Owner Mailing Address City Zip Phone <br /> ��o�`- .� c.ca.n, a.N �7�� r L ft�v/ �r%--�ct � <br /> � /�/ � / f/ f/ �/ w,� z 5�= �3E� <br /> Applicant Mailing Address Ciry Zip Phone <br /> Describe Preposed Work �F�+^�✓� p•--�Y ��p/-G E t—�is �.,..,� 3��r�w „ �,� <br /> .� Cu.c l --o �� ..c f-...� -�v �UG / �-c ��..,../. ro�.. � <br /> /�J S�,e �/ � p..! f.q S /'�5 /rF� �+ /.e .�.� � !��9 C l�yU� <br /> � <br /> Project Address(ii known) � <br /> Attach lour(4)copies ol plans 1or proposed work- Draw to scale and note the following as applicable: � <br /> • Property Lines • Centerline ol st�eet � <br /> • OuNine and dimensions of all ezisting and • Indicate Norih <br /> proposed struclures on the lot • Show any proposed graAing changes <br /> • Existing and priposed utilities • Show measuremenis � <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 1. All calls for inspection shall be made 24 hrs. in advance• phone 2S9•881 5. � <br /> 2. All work shall be performed in acco�dance with�his permit and current City of Everelt Design and Construciion <br /> Standards and Specifications. <br /> 3. Call Location Underground Service 48 hrs. helore you dig.TOLL FREE NUMBER 1•800•424•5555. � <br /> � f�� %iif'�.E'�r/� �c6fsi.LS' J/,qT��� f� �-��S O <br /> �r �cJ cv.�� cur-T�,� � s/�J onJ c�yLc f� <br /> /��t c'y�'� .�c� ��Ty sr/fi�'9.��.S' ,�i�rlc•.�c.�—ic�; ��/� <br /> /l2�zJ �'�O' s� - V♦ <br /> O <br /> a <br /> 09/.30/86 12:16FM OOOqMc^198 ### <br /> ACKNOWLElD'GEME�T OF CONDITIONS <br /> The undersi ned owner/appii 1�qWy,a4r�s,(�hold and save harm- <br /> less ihe Gty of Everett Irom�i antl aIlLi�r�br damages, cosis, <br /> //" expenses, or causes ot ac�iof�N�nay a�2.�ause of installalion <br /> �,_��� �/- and maintenance of tiie impr�nt or �� n�Fobway use hereto <br /> " /--�� yG v��` applied lor and lurther agrees to remove same upon notice Irom ihe <br /> �rove or C r.try `ion i Date City and to replace public property damaged thereby. <br /> / / <br /> /l%O .,yG'E' �%��`�-. c j/�C��o <br /> FINAL INSPECTION Date <br /> Approved as Constructed i natu of Applicent Oate <br /> everett PUBLIC WORKS DEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> � 3200CedarSireet 1B0 DAYS OF DATE PERMIT IS ISSUED ANO THEREAF7ER IS TO <br /> Everett,WA 98201 9E DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Phone: 259-8815 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAVS DURATION. <br />