Laserfiche WebLink
Date .5/�i v�er�wo�wsa,,,mp�i. _ <br /> Application For o�aA.oep�.+___O��� <br /> �UBLIC lIVORKS PERIVIIT 1'uGlicWorkgFeo <br /> To�al Fee S <br /> . Lvsg Appl.Fea Paia $ <br /> Balenco0ue $ <br /> Print or Type Only <br /> C�_I AAO,lMi � �,('Q/3o/ 1i-�.��,-��uttrl /��/2���n JZ'/�/�[/iAL Tss7 /i"'1 <br /> Owner �tailing Address Cily Zip Phone <br /> L-(A � <br /> Applicant Mailin9 Nddress City Zip Phone <br /> Describe Proposed Work VIIJ!/�'� R��l A �_��� ��i�e A �T��J� _ <br /> w <br /> Proi^ct Address�if known) _ � <br /> Attach lour(4) copies of pians for proposed work• Draw to scale and note the lollowin�as applicable: � <br /> • Property Lines • Cenlerline of streel � <br /> • Outline and dimensions of all existing and • Indicate Norih <br /> proposed structures on the lot • Show any proposed grading changes <br /> • Existing and proposed utilities • Show measurements � <br /> DO NOT WRITE BELUW THIS LINE � <br /> PERMIT CONDITIONS <br /> 1. All calls for inspection shall be made 24 hrs. in advance-phone 259•881 5. � <br /> 2. All work shall be performed 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. betore you dig.TOLL FREE NUMBER 1-800-424•5555. � <br /> �/�uc lvo.e.�s' �E,em�i �l/�' �E'qri�,�F� O <br /> ,.� �`/8� <br /> � <br /> � <br /> C��"c/� ��,�i�r/G �q��,e���,�i.s 0 <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees to hold and save harm� <br /> less the Ciry of Everett from any and all claims for damages, cosis, <br /> expenses, or causes of aclion that may arise because of inslallation <br /> and maintenance of the improvement or other right•of-way use hereto <br /> applied for and turther agrees to remove same upon nolice irom the <br /> � Approved for'Consiruction Date City and b replace public property damaged thereby. <br /> FINAL INSPECTION Date <br /> Approved as Constructed Signature of Apolicant Date <br /> everett PUBLIC WORKS DEPARTMENT WORI( AUTH031ZED BY THIS PERMIT MUST BE STARTED VlITHIN <br /> � 3200CedarStreet 780 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everett,WA 98201 BE DILIGENTLI� PUFSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Phone:259•8815 CANCELLED BY �HE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER:0 DAYS DUflATION. <br />