Laserfiche WebLink
iR <br /> " AppliCation F�r � �y[����� --�-$�--�� <br /> � PUBLIC_WORKS PERMIT oa�e_ y'-30— 9� / <br /> � �� �� <br /> PUB�C WORKS DEPAHTMENT Public Works Permit# _7(e / .JF I <br /> �200 Cedar Sireet 7— <br /> ' Eve�WA 98201 259•8810 Builtling Permit H <br /> TYPE OR PRINT ONLY ( � � � Public Works Fe{e.5 .3S'�� <br /> N B/� <br /> 3sSe !� i s � �J /� �� ��p� z s�. - �> � <br /> Owner Mailing l�tlr2+s � ty Zip Phone <br /> Appl�S � � � <br /> Mailing Address City Zip Phone <br /> Describe Proposed Work � ,S ` � <br /> � <br /> � <br /> — v/ <br /> PROJECT ADDRESS(if known) � <br /> Attach four(4)coples of plans for proposed wurk-Draw to scale and note the following if app able: <br /> •Property Lines `putline and dimenslons ol all sxisting and prcposed structures on ihe lot •Ezisting ond proposed utililies O <br /> •Centerline of sireet •Indicate Norih •Show any proposed g�ading changes •Show measuremenis � <br /> DO NOT WRITE BELOW THIS LINE <br /> PERMIT CONDITIONS: � <br /> 7. All calls for inspection shall be made 24 hours in advance-phone 259-8810. O <br /> 2. All work shall be performed in accordance with this permit and current City of Everett Design and <br /> Construction Standards and Specifications. <br /> 3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800-424-5555. � <br /> �— <br /> fL�^�-,� �o /� c/,,,c ��,,_ a�/J.v��: � �C�r�� v/ <br /> d� ��s �- ���� �� �c�� Q�����d> O <br /> a <br /> J ACKNOWLEDGEMENT OF CONDITIONS <br /> � The undersigned owner/applicaM hereby agrees to hold and save harmless <br /> _ ,� ��yL �/��/9� the City of Everett from any and all daims for damages,cosis,expenses,or <br /> ro d for C st cti py e'T— causes of action that may anse because of Installation and maintenance of <br /> the Improvement or other rigM-of-way use hereto applied for and further agrees <br /> �� - to remove same upon notice from the City and to replace public property <br /> V� � - � _5' � damaged ihereby. .� <br /> FINALINSPEC71 Date I <br /> Approved as Constructed ' c��`� <br /> Si/g'naWre of Applicant Date <br /> WORK AUTHORIZED BY THIS PERMIT MUST BE STAPTED WITHIN 180 DAYS OF DATE pERM1T IS ISSUED AN EREAFfER IS TO BE DILIGENTLV PURSUED TO <br /> COMPIEfION.THIS PERMIT MAY BE CANCELLED BY THE CIN UPON ANY STOPPAGE OF WORK ON THIS P OJECT OVER 90 DAYS DURATION. <br /> 1 <br />