Laserfiche WebLink
�i <br /> � � <br /> 4 <br /> � � � <br /> 4 <br /> ���dtDate � �� ✓� '.31 - � � " 5y � -- <br /> Publ¢WorNe Pe/rm�l�Y � z'O� <br /> � Fi Blae.DepL• N� <br /> O Application For <br /> ��� PUBLIC WORKS PERMIT PUUIICWo�keFBe <br /> ,o�a�Fee s <br /> w�+ <br /> �eae nooi.Fee va�a S— <br /> ��p� TO POSTING_� a-� 9�— aa�a��eo�a S zo— <br /> y ty PriM or Type Only � <br /> f] <br /> N <br /> ��� � l— ��n `crn/a-�-• �- � u 7 �/ �� ) o� �c�,n `�C� �� <br /> Owner MaiNng Atltlress City Zip`� Phone <br /> " y �-�7-OS'?U <br /> g� <br /> H <br /> C']Cy fp Appficant � Mailing Address City Zip Phone i <br /> ��fP Describe Proposed Work /`/'[ � � � �^ �� <br /> HOm <br /> / / W <br /> Project Address(if known) �T � � ; <br /> Attach four(4)copies oi plans tor proposed work-Drew to scale an noie the following as applicable: � � <br /> • Property Lines • Centerline of street /A ; <br /> • Outline and dimensions of all existing and • Indiwte North V� <br /> proposed structures on the lot • Show any proposed grading changes <br /> • Existing and proposetl utilities • Show measuremeMs � � <br /> DO NOT WRITE BELOW THIS LINE O �� <br /> `��� �S PERMITCONDITIONS � <br /> 7.All calls for inspection shall be made 24 hrs.in advance-phone 259-8810. j <br /> � I i 2.All work shall be performed in accordance with this permit and current City of Everett Design and Construction � �, <br /> � , Standartls and Specifications. <br /> 3.Call Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1-800•424-5555. i <br /> I C� L � <br /> � � <br /> �� � <br /> � — ' <br /> _�� a i <br /> , <br /> � ,—���. ', <br /> i � �n ACKNOWLEDGEMENTOFCONDITIONS � <br /> 11�L9 <br /> (�./ The undersigned owner/applicant hareby agrees to hold and save harm- <br /> � � �--�— less L.e City of Everett irom any and ali claims for damaqes, costs. <br /> expenses. or causes of action iha! may arise because of installation <br /> � �- antl ioaintenanr.e of the improvement or other right-ot-way use hereto <br /> � � C��SC. h��c K�„ __> ,7� -J� <br /> applied for and fiirther agrees to remove same upon notice from the <br /> P.Pv�o�ed for Consiru ion Date City and to replace public property damagetl thereby. <br /> �/' /��c{:� / y L _ � /l <br /> FINAL INSPECTION Date //9�f� <br /> Approvetl as Constructed Siq�f Applicant Date <br /> PUBLICWORKSDEPARTMENT `NORK AUTHOR�ZED BV THIS PERMIT MUST BF STARTED WITHIN <br /> 3200Ce0arStreet 180 DNVS OF DATE PERMIT IS ISSUFD AND THEREAFTER IS TO <br /> Everett.WA 98201 BE DILIGENTLV FURSUED TO COMPLETION.THIS PERMIT MAY BE <br /> Phone'259-9810 CANCELLED BV THE CITY UPON ANV STOPPAGE OF WORK ON THIS <br /> - PROJECT OVEF 90 DAVS DURATION. <br />