Laserfiche WebLink
Date� U `� , � Pu�l�t Worka Perml�• �� ��� ' <br /> � ! Application For eiav oeau �� � � <br /> PUBLIC WORKS PERMIT PuDh<WorVSFee <br /> � To�al Fee s <br /> Lesa ApD�Fee PGiE S <br /> Print or Type Only ea�a��ao�a s 223_ 22 _ <br /> �/ 3�/ )3 <br /> �ar�l�i,r �f�e !'�Qr��.r�. S�d3 �'o�c���J �o� <br /> Owner Mailing Address City Zip Phone <br /> �e� �(�� ��d.,- ��o� - i�i�a�� �`��3����-- �- 5-,�-3� <br /> Applicant Mailing Address City ip Phone <br /> Describe Proposed Work �/���f/ `�� d � _ _ <br /> r-- <br /> -- -� �� W <br /> Prolect Address(if knownl �d3 � <br /> Aqach four(4)copies ot plans for proposed work- Draw to scale and note lhe following as applicable: � <br /> • Property Lines • Centerline of street � <br /> i Outline and dimensions ol all existing and • Indicate North <br /> propased structures on the lot • Show any proposed grading changes <br /> • Existing and proposed ulilities • Show measuremenis � <br /> DO NOT WRITE BELOW THIS LINE <br /> PERMIT CONDfTlOf75 Q <br /> 1. All calls for inspection shall be made 24 hrs. in aavance- phone 259•881 5. � <br /> 2. All work sha�l be performed in accordance with this permit and current City of Everett Design and Cons[ruction <br /> Standards and Specifications. <br /> 3. Call Localion Underground Service 48 hrs. before you dig.TOLL FREE NUMBER 1•800•424•5555. � <br /> y %o BE Cc��✓s:,ev�rEd PEi l��v.vs AP/�,�c��cl� O <br /> Anld DaTCO �f-�- o'� <br /> Tm.nEni�t��" � <br /> � �y L�-E-� pF�Off- S�TE ST.eEET ZMl�oo!/F/�7Eti'T,S' <br /> �i�raFe' //�► <br /> ,q 8t�.r/D Fo,e �/l�000 iG%lG 8E .C'l-C{u/.eElJ,'b'o.c.�1> �/� <br /> /��l/»$E.2 9B7//DY :�AS �.1�Ov'iDEU �J� TyE ��/�L:CdNT O <br /> �'N 5�/3�es. J�<'.�n✓c/n�cNrS bdic.G v'E Cnm�GErEO � <br /> /'-✓ b'j/ TyE Ao�c.ca•�T bdirir•��d o.vF yF�t .e, <br /> �.�� �/^,,i:9.; <br /> /,. / . . <br /> ���,,�_ �;.,;�=.��•a = ,.�, ��'- .^>, Li , •;, ,'��h� ACKNOWLEDGEMENTOFCONDITIONS <br /> i <br /> r"/�;;<:� -!r l/)�%'> -- �i,; ,) °<r ,•L. '` ,/� The undersigned owner/applicant hereby agrees to hold and save har.m- <br /> — - ic �,.•,. �-. � Iess ihe Ciry of Everett Irom any and all claims lor damages, costs, <br /> ^ �'%°�%"r'� expenses, or causes of action ihat may arise because of installation <br /> � ' '7,�„ ��tl/3�1- and maintenance of the improvement or other right•of-way use hereto <br /> � – =�' ' applied for and further agrees to iemove same upon notice Irom the <br /> Approved(or Cons ructi Date City a�d to replace public property damaged thereby. <br /> ��l! --, �c� r���'/- � -� . ' / � <br /> FINAL INSPECT ON Date� I � <br /> Approved as Constructed Sig( ture pplicant ale <br /> evcret[ PUBLiC WORKS DEPARTMENT WORK HORIZED BV THIS PERMIT MUST BE STARTED WIIHIN <br /> � 180 D OF DATE PEFMIT IS ISSUED AND THEREAFTER IS TO <br /> 3200 Cedar Sireet BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Everet�,WA 98201 CANCELLED BY THE CITY UPON ANY S70PPAGE OF WORK ON THIS <br /> Phone: 259•8Bi5 PROJECT OVER 90 DAYS DURATION. <br /> �r� <br />