Laserfiche WebLink
Datel�{aiL��%�_ <br />.ipplication Far <br />PUBLIC VI/Oi�KS P�RM17 <br />Print or Type Only <br />�.ddlP.55 <br />l� <br />�P+-%-d-�Il---�m ` / i A �r� <br />A �phcanl Mailing <br />Uescri6e Propesed Work <br />Projec� Address lif knawri� <br />Ci�y <br />Atlach tovi;4) copies of plans for proposed work - Draw to scala and nole tiie following as applicable: <br />• Frn�,arty I.ines <br />• OuUine and dimensions ol all existing and <br />propcsed siructures on the �JI <br />• ExiSiing and proposed u�ilities <br />��.�,�,,.�v�,�:��„�,,,� __ <br />;�n� ot�ai., .�/ZJ d'Q�._ <br />/ <br />runer. worrs Fco <br />tnmiFee 5 <br />loss ApPI FnH Pm� $ <br />�alancc Dun $ <br />• Cente�Gne cl street <br />• Indicale Norlh <br />• Show any proposed grading chanpes <br />• Shoev measurements <br />a�a2 — <br />PERMIT CONDITIONS <br />1. All calls lor inspeclion shall be made 24 hrs. in ativance • phone 259-5810. <br />2. All work shall be p2rtormed in accordance with this permit and current City of EvereU Design and Construclion <br />Standards and Specificalions. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1•800•424-5555. <br />/'(�l��%r, l�'�`,"— �i „�,� � /j/�! ✓�, 1-r-�c.-: �:<!' <br />Approved for �onslruction <br />��� //f' �y /> <br />a /��–(�% <br />ACKNOWLEUGEMENT OF CONDITIONS <br />W <br />� <br />� <br />N <br />� <br />O <br />__ The unc�rsigncd oemer/applicant hereby agrees to hold anc aave harm� <br />— less the City ol Everett Irom any and all claims for damages, costs. <br />�zpensee or causes of action Ihat may anse because of installation <br />and maintenance of the improvement or other right-of-way use hereto <br />------ — apP��ec1 lor and furiher agree, to remove same upon „otice I�om Ihe <br />Date City anu to replace public property damaged Ihaeby. <br />I INAL INSPEr,TIOM Date <br />APPruvF J as � � i,D _,�ted <br />eveie�t PU9LlC WORKS DEPARTM[NT <br />� 3200 CedarSlreet <br />Everetl, WA 98201 <br />Phone:259-8810 <br />Signa�ure ol Applicanl p��� <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WIiHIN <br />tA0 DAYS OF DqTE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PUFSUE� TO COMPLETION. TIi15 PERMI? MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OV[R �G DA'IS DURATION. <br />