Laserfiche WebLink
Date��6�e a�oi��wo,xs ve�mn /n'� -- <br /> Application For a�ne oeo��+ --LW <br /> PUBLIC WORKS PERMIT Pu�TOInIFcoFeo S — <br /> Lass AOPI.Fee Pald S <br /> oaiance Due S <br /> Print or Type Only <br /> (./� �P�IM Mn� � ��Jr �.121�Cm1.� /V�r� (�� <br /> Owrer Maihng Ad ress Gty ip Phone <br /> r <br /> ��ar �-'� �11LI /s v�S�1'/7SC) <br /> Applicant Ma�ling Address City Zip Phone <br /> Describe Proposed Work <br /> W <br /> Project Adtlress(il known) �� a H <br /> Attach four(4) copies of plans lor proposed work- Draw to Scale and note the following as applicable: � <br /> • Property Lines • Centerline ol street � <br /> • Outline and dimensions of all existing and • InAicate North <br /> proposetl structures on Ihe lot • Show any Uroposed yrading changes <br /> • Existing and proposed utilities • Show measuremenit /M <br /> W <br /> DO NOT WRITE B[LOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 7.All calls for inspection shall be made 24 hrs.in advance•phone 259-881 O. � <br /> 2.Ail work shall be pedormed in accordance with this permit and current City of Everett Design and Construction <br /> Standards and Specifications. <br /> 3.Call Location Underground Service 48 hrs.belore you dig.TOLL FREE NUMBER 1•800•424•5555. � <br /> ,��.(.�� ���- y�-�L.�:-�-�, •�'�- �°� �..��' 0 <br /> � - �- <br /> � � <br /> .� ����t� -�a� N <br /> �oZ�� 2�,��,1� ��oTl��u7 �-L� `�;'�z � u:�,�. 0 <br /> �� �G � ��� a <br /> � � ,���>c��-��'z� �- �'f' Q^� .,� <br /> �,,� � /'-�.C�v /�.'QGv. a-a <br /> ACKNOWLEDG[MENT OF COND�T ONS 8—Z cy� <br /> The undersi�ned owner/applicant hereby agrees tu hold and save h�rm• <br /> less the Ci�y ol Everelt Irom any and all claims for damac�es, cos�s, <br /> expenses. or causes of aclion that may arise because of installation <br /> � and maintenance ol lhe improvemenl or olher righ�•ol�way use here�o <br /> applied for and lurther agrees to remove same upon notice Irom the <br /> Approved for Construction Date City and to replace public property damaged thereby. <br /> FINAL INSPECTION �� � ���M � � �/J o <br /> Date � Date <br /> Approved as Constructed Signature ol Applicant <br /> WORK AUTHORIZED BY THIS PERMIT MUSi BE STARTED WITHIN <br /> everett PUBLICWORKSDEPARTMENT 180 DAYS OF DATE P[RMIT IS ISSUED ANG THEREAFTER IS TO <br /> � 3200CedarStreet BE DILIGENTLY PURSUED TO COMPLE710N. THIS PERMIT MAY BE <br /> Evere�t.WA98201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone:259•8810 PROJECT OVER 90 DAYS DURATION. <br />