Laserfiche WebLink
�BtB �I •I PuONe WOM�Pum�1• <br /> Appllcetlon For eiao o.w • _ <br /> PUBLIC WORKS PERMIT °°°;a„F.aFN .- <br /> La���pD��as P�M � <br /> B���ncs Oua / <br /> Print or Type Only <br /> "ff�e f3°E'�` c��MeiHn�Ad�s BOX 3'101 MIS vF-1� ,S�MrLE �Wh.h981Zy <br /> zcc —3t63 <br /> S�E <br /> Applicant Malling Addrssa Clty 2ip Phone i <br /> Describe Proposed Work �P��A'Lv 3 Saa L r � r G�I'a��Ll n/K �-(�^!�.{f I <br /> W <br /> Prolect Addresa lil knownl � <br /> Attach laur(4)cOpiea ol plene lor proposed work• Draw to acale and note Ihe lollowing as appticable: � <br /> • Property Linea • Cenlerline ol atreet � <br /> • Outline and dimenaione ol all eaisting and • Indicete North <br /> propoaed etructures on Ihe lot • Show any propoaed prading c�enges <br /> • EKisting and proposed utllities • Show measurementa � <br /> UO NOT WRITE BELOW THIS LINE O <br /> PERMIT CO'IDITIONS <br /> 1.All celle for Inepection ehall be made 24 hre.in edvance•phone 259�88�0. � <br /> 2.All work ehell be paAormed In occordence wlth thia permit end cuRent City o!Everett Deeign end Conetrucllon <br /> Stenderde and Speclllcafiona. <br /> 3.Call Localion Undergraund Service 4B hre.before you dlp.TOLL FREE NUMBER 1•800-424•5555. � <br /> O <br /> � <br /> � <br /> O <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> C� ihe undersignetl owner/epplicanl here6y eBreea lo hotd and aeve harm- <br /> less Ihe Cily ol Everetl Irom eny end all clelms lor demagea, coets. <br /> e■penses, or causes ol action that mey arlee because ol Installatlon <br /> end mainlenenca ol the improvemant or othar riphbnbway use hereto <br /> Approved for Const�uction Date epplied lor and lurther agiees to remova name upon notice Irom the <br /> C�ty end lo raplace public property demeped Ihereby. <br /> FINAL INSPECTION Dete <br /> Approved BB Constructed Signature ol Applicent Dale <br /> everett PUBLIC WORKS OEPARTMENT WORK AUTHORIZEO BV THIS PERMIT MUSt BE STAqTED WITHIN <br /> � 3200CedarStreat 1B0 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everet�WABB201 BE DILIGENTLV PUHSUED TO COMPLETION.THIS PERMIT MAV BE <br /> Phone:258•8810 CANCELLED BV THE CITY UPON ANY STOPPAQE OF WORK ON THIS <br /> PROJECT OVER 90 DAYS DURATION. <br />