Laserfiche WebLink
I� <br /> Date�_ 1 P���,�wo,�.r�,m��. <br /> I � I�-, <br /> Applicatlon For e�oc oeo� •�i�_• � _� � _ <br /> PUBLIC WORKS PERMIT PuLiicWo�k�Fee <br /> Tolel�ee � <br /> la�*FO����e Pa�E S <br /> Beience�oe s <br /> Print or Type O�ily <br /> sJr��� �'� l��l��a ir� il� �� l�:�i� (� = � �� ti������- ���� �a� i -����,�� :=f�=�.� <br /> ON�ne�� �l'•_ Mailing Address City Zip Phone <br /> —.� ��1� . <br /> Applicent Mailing Address City Zip Phone <br /> Describe Proposed Work � �I����� I <br /> Pro�ecl Add�esa(il known) � � � � <br /> _ � <br /> Attach four(4)toples ol plans for proposed work• Draw to acale end note the followinp as appliceble: � <br /> • Property Linea • Centerline of street � <br /> • Outline end dimenslone of all exisling end • Indicate North <br /> proposed slructuree On ihc lot � Show eny proposed greding changes <br /> • Exlstinp and proposed utilitles • Show meesurements � <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 7. All cells lor Inapectlon shall be mede 24 hra in advance•phone 259•881 5. � <br /> 2. All work shell be perlormad in accordance with this permit end cm�ent City ol Everett Design enA Construclion <br /> Standards antl Speclllcatlons. <br /> 3. Cal{Locetion Underground Service 48 hrs. belore you dig.TOLL FREE NUMBER 1•800•424•5555. � <br /> 9:J -8� O <br /> /UD f'UBG/G C(�U,�-�s' ��'�i�iT',�"�'c?�i,�-� `�� � <br /> `t� <br /> � <br /> O <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The unde�signed owner/epplicanl hereby agrees to hold and Bave herm• <br /> less �he City ol Everett Iram any end nll clalms for damages, cost& <br /> expenses, or causes of aclion thai mey arise bacause ol instelleflon <br /> and malntenence ol the improvemant or other right�of�way use hereta <br /> applied lor and further agrees to remove eame upon notice Irom Ihe <br /> Approved lor Conslructlon Date City end to replace public property damaged thereby. <br /> FINAL INSPECTION Dale <br /> Approved as Const�uded Signalwe ol Applicant Datc <br /> everetl PUBLIC WORKS OEPARTMENT WORK AUTHORI2ED BY THIS PERMIT MUST BE STARTED WITHIN <br /> � 3200 Cedar Street iB0 DAYS OF UATE PERMI7 IS i55UED AND TNEREAFTEP IS TO <br /> Everett,WA 98201 BE DILIGENTLY PURSUED TO COMPIETION. THIS PERMIT MAV BE <br /> Phone:259-BB15 CANCELLED BY THE CITV UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAYS OU(iAT10N. <br />