Laserfiche WebLink
Date S�� v�ee�we,A�r,,,m��. <br /> AppliCedon FOf <br /> Bley Deo� • 36576 <br /> PUBLIC WORKS PERMIT ^°°;o,�FeeFea � <br /> lee��ppl iee P�IU 6 <br /> B�iencn Oue f <br /> Print or Type Only <br /> Boeipo c' an a., »m uic nc �g SPAtEIP wa a8t2d AA9—SR7R <br /> Ownet Mailing Address Ci�y Lp Phone <br /> Ovmer <br /> Appllcent Mailing Addres6 C Y ZiP Phona <br /> Deecr�be Propoaed Work �natruct concrete ductbank <br /> W <br /> Pro�ect AAdrese(il known) 3003 W. C881710 F1i. � <br /> Allach lour(4)copies ol plene lor proposed work- D�aw to scele end note Ihe lollowing ae applicable: � <br /> • Property Linea • Centerlina ol street � <br /> • i�utline and dimenelons ol ell exlating end • Indicate North <br /> piopoeed strucluree on the lol • Show eny proposed grading chenges <br /> • EMisting end proposed utllitles • Show meesuremente � <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMITCONDITIONS <br /> 7.All celle for Inepectlon ahell be mede 24 hra.In edvence•phone 259•8810. � <br /> 2.All work ehell be peAormed In accoNence with Ihia permit and current City oi Everett Dealgn and Conetructlon <br /> Standerda end Specllications. <br /> 3.Call Location Underground Servlce 4B hra.belora you dig.TOLI FREE NUMBER 1-800�424•5555. � <br /> I�U�it C.J�IW� �/-�,n..r ,'f/`9/ ���u[t�� / o <br /> .�� J H <br /> � `' ` V� <br /> �- y , <br /> � <br /> a <br /> � <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> ihe undersigned owne�/epplicnnt he�eby agrees to hotd and save herm� <br /> less the Cily of Everett fiom eny and ell claims for dameges, costs, <br /> expenses, or ceuses �1 ection thnt mey ariae Deceuse of inslellation <br /> and meintenanr.e ol ihe improvemenl or o�her right•ol-wuy use herelo <br /> epplied for and lurl�ar egrees lo remove seme upon nolice Irom Ihe <br /> Approved for Constructlon Dete City and to re�Ja:.e Fublic property demeged thereby. <br /> FINAL INSPECTION Date — <br /> Approved es Constructad Signeture ol Applicant Date <br /> � PUBIICWORKSDEPARTMENT WORK AUTHORIZED BY TNIS PERMIT MUST BE STARTEO WITHIN <br /> 180 DAVS OF DATE PERMIT IS ISSUED AND THEfiEAFTER IS TO <br /> 3200CederSlreet BE DILIGENTLV PURSUED TO COMPLETION. THIS PEPMIT MAV BE <br /> Evarel6 WA 98201 CANCELLED BY THE CITV UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone:269-BB1p PROJECT OVER 90 OAYS DURATION. <br />