Laserfiche WebLink
Date L J � r�ni��wo�ws re� �/�/— <br /> App�icatlon For ema oeoi • <br /> PUBLIC WORKS PERMIT Purytot�ieeFe� � - <br /> Lees�Do�iee VnC f �7 <br /> Oeience0ue � L� <br /> Print or Type Only <br /> T'��ui(�T LUf�I'Tm�U� ���. C�51�� �J�- <br /> � Ownar Mailing Address Ci1y Zip Phone <br /> .���r�' �.l� �n�-t p n �i �-t� �� ��- a 5�11�1 <br /> Applitant MaIImB Address Ctly 2ip phone <br /> Deecrlbe ProposeE Wo�k ����1 <br /> � W <br /> Pro�er1 Addreae III known) �� � <br /> Atteth lour(4)copiee ol plane lor proposed work• Draw�o scale end nole Ihe lollowing as applicable: � <br /> • Pmperty Unee • Centedine ol sVeet � <br /> � Outline and dimenelone ol all e�isting anA • Indicale North <br /> prDposetl e�rucluren on Ihe lol • Show eny pr�posed greding changes <br /> � Exltling and proposed�iilillas • Show measuremenla � <br /> DO NUT WRITF BELOW THIS�INE O <br /> PERMIT CONDITIONS <br /> 7.All celle lor Inapectlon ehall be mada 24 hre.In edvance-phone 259•8810. � <br /> 2.All work ehell be peAormed in eccordance with thia permit and currenl Cily ol Everett Deslgn a�tl Conatru��tlon <br /> 3tenderde and Speclfice!lone. <br /> 3.Call Locatlon Undarg�ound Sarvica 48 hre.before you dig.TOLL FREE NUMBER 1•800•424-5555. � <br /> O <br /> � <br /> � <br /> O <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The underslgned owner/epplicant hereby agreas lo hold end saee harm• <br /> less Ihe Gty ol Everelt from nny and all cleims for dema0ea, cosls, <br /> eMpenses, or causes of eclion thet may arlse beceuee ol instellalion <br /> and meintenance of the improvemenl or olhe� righl-ol-wey usa herelo <br /> applied lor end lurthor e0raes lo remove eame upon notice I�om the <br />� App�oved�or ctlo _ Dale C�ty end to replace public property dameged Ihereby. <br /> FINAL IN ECTION ��� ,� �y / �� /7� � <br /> Appmved ea Conetructed Signetur�.s.J�c.�,�j��_ <br /> everctt PUBI�CWORKSDEPARTMENT WORK AUTHORIZED BV THIS PERMIT MUST BE SIARTED WITHIN <br /> � 3200CedarSireet 180 DAVS OF UATE PERMIT IS ISSUED AND THEHEAFTER IS TO <br /> Everelt,WAB8201 BE DILI6ENTLV PURSUE� TO COMPLEiION. THIS PEFMIT MAV BE <br /> Phooe�.259�8810 CANCELLED BV THE CITV UPON ANV STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAVS DURATION <br />