Laserfiche WebLink
� <br /> i � ^ �- <br /> I Date� F„��,�wo.��P <br /> APp�iCa�ion For emq Deu� •�� y�� <br /> I <br /> PUBLIC WORKS PERMIT PJbTO�AIFpB`CB s_ <br /> �acs nroi Fee va�o 6 <br /> Print or Type Only ea�s�«o�� s _ <br /> a��� � ,�L�:���� qf�J I �:s��-5188 <br /> _� <br /> Owner Madiny Atltlress Ci Zip Phone <br /> C�h►���''s�►�� ►�-� � i�39 �'� pr�H-4S� a�--�7 <br /> App6caM Maihng Address City 2ip phone <br /> Descr�bc Proposed Work !�Y /! K � �(JI / <br /> Prolect Address Id known) �c `��',,,_ � <br /> Aflach lour�4)copies ol plans for proposed wo�k� Draw lo scale and nole ihe�fe ing as applicable: � <br /> • Property Lines • Centerlme ol street � <br /> • Outline and dimen5ions of all existing and • Indicale North <br /> proposed structures on ihe lot • Show any proposed grading changes <br /> • Existing and p�oposed utilities • Show measurements � � <br /> DO NOT WRITE BELOW THIS IINE <br /> PERMIT CONOITIONS O <br /> 1.All calls for inspection shall be made 24 hrs.in advance•phone 259•8870. � <br /> 2.All work shall be pedormed in accoriance with ihis permit and current Ciry of Everett Design and Constmction <br /> Standards and Specifications. <br /> 3.Call Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1-800•424•5555. � <br /> � � <br /> �,�, ���� -,.�� -.1� ��� 11'T 1�'� � � � <br /> �-� _ � _ �: ��� (� <br /> �? � � <br /> a <br /> �fl�✓ AGKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant he�eby agrees to hold and save harm� <br /> less the Cily of Evere�� Irom any and all claims lor damages, costs. <br /> expenses, or causes ol action ihat may arise because ol insiallation <br /> I and maintenance ol the improvement or other righPobway use hereto <br /> applied lor and furfher agrees to �emove same upon notice trom Ihe <br /> Approved lor Conslruction Date City and to replace publlc property damaged thereby. <br /> FINAL INSF'ECTION Jate <br /> Approvad as Constructed Signalure ol Applicant Date <br /> evereU PUBUC WORKS DEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> � 3200Cetla�Street 180 DAYS OF DATE PERMIT IS ISSUED AND TNEREAFTER IS TO <br /> Evere�t,WA 98201 BE DILIGENTLY PURSUED TO COMPLETION. THIS PERI�AIT MAV BE <br /> Phone:259�8810 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVEF 90 DAYS DURATION. <br />