Laserfiche WebLink
[[�� �^ 8N-�9� <br /> �BIB�U Pubi�c WorF�P <br /> Applicatlon For ema oeo� � <br /> PUBLIC WORKS PERMIT "���'cWorh�fea <br /> Ta1�l Fee s <br /> leu�oo�.Fea Pud S� <br /> Bslenw Due s_ ��� <br /> Print or Type Unly _ <br /> �IC��Y�1'Za rW!'�Y' 4'�(�U I �VZ1C.P LQl'1C �ip� ��_%� <br /> iOwner Mailing Address City Zip phone <br /> � �rin t-��r►-1�� �,� �..tw �3� � <br /> ApPllcent MaihngAddress City ip phone <br /> Deecriba Propoaed Work �11 1 ��� . _ _ <br /> Pro�ect Addreas pf known) ��/1J�— [I.dG.E'1� �L � <br /> Atlach four�4)copies of plans lor propoaed work•Draw lo scale and note Ihe lollowing ae appliceble: � <br /> • Property l Inea • Canterline ol slreet � <br /> �Outllne end dimensions of ell exietinB and • Indicale No�th <br /> propoaed structurea on Ihe lol • Show any proposed B�ading chenges <br /> • Ealslinp and propoaed utilitles • Show measuraments � <br /> DO N T WRITE BEl W THIS LINE O <br /> PEP,MIT CONDITIONS <br /> 1.All cslls for Inspectlon ahell be made 24 hra.In advanca•phone 259�8810. � <br /> 2.AII work ehall be peAormed In accordance with Ihle permit end currenl City ol Evorett Deaign and Conetructlon <br /> Standards end SDecilicatlona <br /> 3.Call Location Undarground Service 48 hre.belore you dig.TOLL FREE NUMBER 1•800�424•5555. � <br /> I O <br /> � <br /> � <br /> O <br /> a <br /> (_ ACHNOWLEDGEMENT OF f:ONDITIONS <br /> F� The undersigned owner/epplicant he�eby aqrees to hold and save harm� <br /> less Ihe Clry ol Everelt Irqm eny and all claims lor demeges, cosls. <br /> eKpenses. o� causes ol aclion that may eriae because ol instellation <br /> � �� and n�2inlenance of �he improvemen� or other ripht•ol�wey uae hereto <br /> � " � applied fo� entl lurther agrees to remove same upon no�ice from Iha <br /> App e for onytrucflon � Oale ���y and lo replace public property dameped Ihereby. <br /> / <br /> ��' ,� -�-�/5' / _ <br /> SPECTION � Date `��-�k <br /> 'At�w d Sig ture of Applicant � Date <br /> everett PL�BLIC WORKS DEPARTMENT WORK AUTHORI.ED Y THIS PERM T MUST BE STAR7ED WIiHIN <br /> � 3200CetlarStreet 1B0 DAYS OF DATE PERMIi IS ISSUED AND THEREAFTER IS TO <br /> Eve�et4 WA9B201 BE DILIGENTLY PURSJ[D TO COMPLETION. THIS PERMIT MAV BE <br /> Phone:259�8810 CANCELLED 8Y THE CITV'1PON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAVS DURATION. <br />