Laserfiche WebLink
Date � /��'S 8s <br /> Public Works Parmlt• <br /> Application For . I aia9.oen�., <br /> PUBLIC WOR�:S P�ERMIT ��r PueTotelFeaFae s_ `�, � <br /> Leaa qpo�Fea Paitl S� <br /> Print orType Only �3 sa�a�<ao�a S_�Z3 <br /> TEK Rf} ,(�_F/}L_TY,���/iiFr�aF��— 1'o8lA'9� �yNNu rr�,� 9f,'d3� 7� 3�- �7,�o� <br /> Owner Mailing Address City Zip Phone <br /> Applicaot Mailing Address City Zip Phone <br /> Describe Propose�Work �ou i H/'o//✓�" jl,fl z�q �F� S i�F S�/�y7 i�/c�l�Jt/�,� <br /> Project Address(if known) T ���`�T L ? � � �- � <br /> Attach four(4)copies of plans for proposed work• Draw to scale and note ihe tollowing as applicable: <br /> • Property Lines � <br /> • Centerline of street � <br /> � Outline and dimensions ol all existing and • Indicate North <br /> proposed structures on!he lot • Show any proposed grading changes <br /> � Existing and p:oposed ufilities • Show mcasurements <br /> D6 NOT WqITE BELOW TfIIS LINE � <br /> PERMIT CONDITIONS � <br /> 1. All calls for inspection shall be made 24 hrs. in advance• phone 259•881 5. <br /> 2. All work shall be performed in accordance with this permit and current Cily of Everett Design and Construction � <br /> Standards and Specifications. <br /> 3. Call Location Underground Service 48 hrs. before you dig.TOLL FREE NUMBL-R 1•800•424•5555. <br /> 1T /---o'lr CL/��ror�4� ��C""�r-` � <br /> � O <br /> �1 , D7�' S/T i� S/�Y/J1 c7"{'2 �NQfyL� �I (�/. <br /> �� , �- <br /> � <br /> � <br /> a <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 lor damages, costs, <br /> � - expenses, or causes of action that may arise 6ecaus� of installation <br /> i <br /> 2� 7 �l A�- and maintenance of the improvemr.nt or other right-obway use hereto <br /> Approved lor Constrp ion Date applied for and further agrees to remove same upon notice hom the <br /> iio n i City and to replace public property damaged thereby. <br /> ������ � �9 � � ��in <br /> FINAL INSPECTION Date w �'4� /� �5�.�", <br /> Approved as Constructed Signatur of Ap icant Date <br /> evere[t PUBLIC WORKS DEPARTMENT WORK AUTHORIZEO BY THIS PERMIT MUST �[ STARTED WITHIN <br /> � 3200 Cedar Street 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everett,WA g8201 BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Phone: 259�6815 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAYS DURATION. <br />