Laserfiche WebLink
'1 <br />r Date�? �^p � <br />Applicntion For <br />PUBLI VI/O�RKS <br />Print or Type Only <br />Owner <br />qpplicant <br />Desc;ibe Proposed Work <br />Project Address (if km�•,vn) <br />� <br />� <br />PUNic Works Pe�mil • Ja�p <br />eia9� oeo�� • _ <br />�' � R M I T Public Works Fee -�1! <br />Ta�a�Faa s ao <br />less AppL Fea Prtitl � � <br />Balance Due $ � <br />��C, 7 Z 5�9.3 <br />I ( 31 �v �� � r-��v <br />Mailing Address <br />U \� <br />Mailing Addre�s <br />� <br />Attach four (4) copies of plans (or proposed work • Draw to scale and note tiie-fa o�g as applicable� <br />• Properly Lines O Cent„rline of stree� <br />• Outline and dimensions of all exisling and • Indicate North <br />proposed structures on the bt � • Show any proposed grading changes <br />• Existing and.proposed utilities • Show measurements <br />�-- <br />� <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 accordancr. wilh Ihis permit and cu,-rent City ol Everett Design and Construction <br />Standards and Spec�(ications. <br />3. Cail Location Underground Servi�e 48 hrs. betore you dig. TOLL FREE NUMBER 1-800•424-555Ci. <br />I• `�'� �/iJ/�G'E t.J/G t_ �'� Cc� i1lTi�oG�e-a �{j r .O/if'CcTa�ca <br />�� �/���c7�,e. �l...G �J✓.Pi9,-y�?c-:c �� f�/.vi.'�7� <br />�j�'��c%2%y uJ/GG �r �'�-�%�j/+�aC"i Cl!'1� S/i�� <br />�O — <br />ACKNOWLEDGEAIEN7 OF GONDITIONS <br />The undersignetl owner/epplicant hereby agrees to hold and save harm� <br />less the City of �verett trom any and all claims for damages, cosh,. <br />er.penses, or causus ol action ihiat may arise because of inslallation <br />and maintenance of lhe improvernent or other right-of-way use heraro <br />ap r and luriher agrees to remove same qon nohce Irom the <br />ity and to r�place public propQrhr da@ag8- ergby. <br />� <br />ApprovEd ts <br />evemtt <br />� <br />PUBLIC �J�S DEPARTME <br />3200 Cedar Street <br />Everett WA 98?01 <br />Phone: 259-8815 <br />aigwrrr rrorv.ypiicanl Lj� �� � Date <br />RK AUTHORIZED BY THIS PEAMIT MUST BE STARTED WITHIN <br />780 DA'IS OF DATE PERMIT IS ISSUEG AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETIO!�l. THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON f,NY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS UURATION. <br />L ,.� <br />