Laserfiche WebLink
- a 4 ' <br /> Date � �� , Pu0licWo�knPe�mit+ 9`I' <br /> Application For ema.oeo��• <br /> PUBLIC W�ORKS PERMIT PublicWorkaFee <br /> TOL-:Foe s— <br /> Lean A00�Foe Paitl S�-- <br /> Print or Type Only j ea�a��oo�a s _25`� <br /> ��y00 �P�Ylas ��-i' l23i �vaa�t��,y �v���zl`_" �k�d / �,�1-37�� <br /> . �Owner Mai4ing Address �—CiI—Y � Zip Fhone <br /> ii i . <br /> / � S t) YI�' '�-' 1 ' ` . <br /> � Applicant Mailing Address City Zip Phona <br /> / <br /> Describe Proposed Work 1` a �1�/17^C �� e S �� {"�'u C/� K ��c7 d�, /e(/`'(%� <br /> ✓ <br /> � ^� W <br /> Project Address(if known� '� G� �a Y� c Y y��-� f�' p ! � � O � <br /> Attach four�4)copies of Plans for proposed work- Draw to scale and note the following as applicable: � <br /> • Property Lines • Centerline of street ♦� <br /> • Outli�e and dimensions of all existing and • Indicale North V'/ <br /> proposed structures on the lot • Show any proposed grading changes <br /> • Existing and proposed utilities • Shovi measurements �A <br /> W <br /> DO NOT WR�fE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 1.All catls for inspection shall be made 24 hrs.in advance•phone 259•881 O. � <br /> 2.Ail work shall be peAormed in accordance wlth this permit and current City of Everett Design and Construction <br /> Standerds and Specificetions. <br /> 3.Call Location Underground Service 48 hrs.6efnre you dig.TOLL FREE NUMBER 1-800�424•5555. � <br /> �{. '�fO570�1 G�'E"XG� Wlust h� PrOv�ded as d�rcc�e.d � -thG ���CG <br /> �O✓�.S �'1SpU--1�ir'. �e� G,� S�G-�S G�GZ.�✓� .T.'t GlI 'f'a�'1P3S. O <br /> 5 , 1�o mz�tr'-r:� l s�u� l be }w��d-6� -l�.e- s;tc - rJo r��'sk;ri <br /> (� SaS � D✓I S��G . I ��is �ymi� --�r YYly1.Cl�tMG �OE' Gl�r'11'1qo✓���• � <br /> V <br /> O <br /> � <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> �� The undersiyned owner/applicant hereby agrees to hold and save harm- <br /> less the City of Everett from any and all claims for damages, costs, <br /> ---���""� ezpenses, or causes of ac�ion that may arise because of installation <br /> ')Ap�fj� _ _ / .-. 7—G�� and maintenance of the improvement or other �ight•ohway use hereto <br /> �°� [w`— applied for and further agrees to remove same upon notice from the <br /> Approved for Construction Date City and to replace publi roperty damaged thereby. <br /> � <br /> �1�� �if _� <br /> FINAL INSPECTION ate Date <br /> Approved as Constructed Signatu of Applicad <br /> ���� PUBLIC WORKSDEPARTMENT WOR AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> 180 DAYS OF DATE PERMIT IS ISSUED AND TH[REAFTER IS TO <br /> 3200CedarStreet BE DILIGENTLY PURSUED TO COMPLETION.THIS PERMIT MAY BE <br /> Everett,WA 98201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone:259-8810 PROJECT OVER 90 DAYS DURATInN. <br />