Laserfiche WebLink
Fubuc Wodt Permit• V� � � <br /> Date /° �3 <br /> ema ono� • <br /> Applitetion For <br /> PUBLIC WORKS PERMIT PubTotelFeeFe' : a�• o �o <br /> lesa ApO�Fee Pa�O s <br /> Belence0ue Q�O. O � <br /> Print or Type Only <br /> �Q,r�e � � (� o1�-u �" � � I S L��� (�,4.��- 9 g�o_3 � S�'._.a I l `� <br /> Owner Maillnp Address Cit Lp Phone <br /> � `�i�v-�-�-. / �a � /�.Q �-�-u� R98a3 t4SS_8� 9-3 <br /> �.`�` <br /> qpplica Mailing Address City 2ip Phone <br /> f /� /� .� <br /> Describa Proposed Work <br /> �l.l /� � Q LhLA—Ll.. ,r�...n _ _ <br /> / W <br /> Pro�ect Address(il known) Z Z' CU � d � <br /> Atlech lour(4)copies ol plans for proposed work• Draw to alo end note Ihe following as epplicable: � <br /> • Property Lines • Centerline ol stree� � <br /> • Outline end dimenaions of all ezlstinB end • Indicete Norlh <br /> proposed structuies on the lot • Show any proposed 8rading chenges <br /> • ExIs11nB end proposad utllities • Show measuremenls M <br /> W <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITION£ <br /> 1. All calls for Inspection shell be mede 24 hra. in edvence- phone 259•88�5. � <br /> 2. All work ahell ba perlormed in accordance with�hls peimit and current City ol Everett Design end Construc�lon <br /> Slendards and Specilicalions. <br /> 3. Cell Locetion UnderBround Service 48 hrs. befo�e you dig.TOLL FREE NUMBER 1•800•424•5555. � <br /> O <br /> � <br /> � <br /> O <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/epplicanl hereby egrees to hold end save herm� <br /> - less the City ol Everelt Irom any end all claims lor damagea, cosls. <br /> ezpenses, nr ceuses ol actlon lhel mey arise 6acause ol Inslellatlon <br /> / i e ��� and malntonence af Ihe improvement or olher !i�h�•ol-wey use hereto <br /> applied for end further egrees to remove 6Bme UpOn no�iCe Irom Ihe <br /> A lor onstructlon �e City and�o replace puhlic property damaged lhereby. <br /> �� /,/ � � � //� <br /> � � � �`7/`L� �{ i L/ // <br /> FINALINSPE TION Det �I'�rI'��LK ��"�"- <br /> Appioved as Conslructe <br /> Signnt re of ApP��canl —�- Date <br /> WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> evrrett PUBLIC WORKS DEPAR ENT 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � J'l00 Cedei Slrcel BE DIIIG[NTLV PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Everett.WA 98201 CANCELLED�V THE CITV UPON ANV STOPPAGE OF WORK ON THIS <br /> Phune�. 259�8015 PROJECT OVER 90 DAYS DURATION. <br /> � <br />