Laserfiche WebLink
Oate_�951 ' PUUIic Woeke Porm�t s B�— /• <br /> Appiication For eiop.oen�.+ r ' <br /> PUBLIC WORKS PERMIT PuElitWorkaFee � <br /> Totel Fee S <br /> Leaf ApO�Fae PeiE S <br /> Print or Type Only <br /> aa�e��e o�a s 66 00 <br /> Ow�� '��SL.(��''�/�'� I��� �1��� ��-- ya,�� �s�- �r.�� <br /> " Mailing Addres•. ` City Zip Phone <br /> �1�..� U�,��� �� �D �na' /Od� Z� �7�s—� —(y�/ <br /> Applicant Mailing A�dress City Zip Phone <br /> Describe Proposed Work � «* �-� v `�' � <br /> �T— <br /> V <br /> Proiect Address(il known) — � J ��u� _U� � � <br /> � <br /> Atlach four(4)copies ot plans lor proposed work � Draw to scaie and nole the lollowing as applicable: � <br /> • Property Lines � Centerline of sVeet � <br /> • Outline and dimensions of all existing and • Indicate Norlh <br /> proposed structures on the lot • Show any proposed grading changes <br /> • Ezisting and proposed utilities • Show measurements � <br /> DO NOT YJRITE BELOW TI1I5 LINE O <br /> PERMIT CONDITIONS <br /> 1. All calls lor inspection shall be made 24 hrs. in advance-phone 259•881 5. �� <br /> 2. All work shall be performed in accordance with ihis permi� 2nd curren�Ci�y of Everet� Design and Conslruction <br /> Standards and Specifications. <br /> 3. Call Location Underground Service 40 hrs. belore you dig.TOLL FREE NUMBER 1•800•424•5555. � <br /> 7� T �� CONST,C�UL7E0 PEi2 f�s�i'-�'o✓EU O <br /> S/�� �iC9�J D�9TEj1 / -20-87 <br /> � <br /> � <br /> O <br /> a <br />� ACKNOWLEDGEMENT OF COND�TIONS <br /> The undersigned owner/applicant here6y agrees to hold and save harm- <br /> � less the City of Everett from any and all claims for damages, costs. <br /> ��%�r�` expenses, or causes of action that may arise because of installation <br /> � � �� and mainlenance of lhe impr vement or �r right-ol-way use hereto <br /> applied fur and furlher ag s to rem same upon notice trom Ihe <br /> Approved for Con clion a�e City and lo replace pu ' oper ereby. <br /> � C/G`j ( � <br /> FINAI.INS�P CTION ale <br /> Approved as Constructed Siqfiature App icant a�e <br /> everett PUBLIC WORKS DEPARTMENT WORK UTHORI2ED BY THIS PERMIT MUST BE STARTED WITHIN <br /> � 3200CedarStreet 780 D YS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> EveretC WA 98201 BE DILIGENTLY PURSUED 70 COMPLETION.THIS PERMIT MAY BE <br /> Phone:259•8815 CANCELLE�BY THE CITY UPUN ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OV[R 90 DAYS DURATION. <br />