Laserfiche WebLink
� <br /> � <br /> �l <br /> Date_�y�Y " � ��5� �b?O <br /> Public Worke Permit� <br /> Application For o�ae�oeo�-+ <br /> � �7 /7 <br /> PUBLIC WORKS PERMIT PUGToIeIFeeFeo s <br /> �ess noo�Fea ram S <br /> 9alanco Oue S �U�, <br /> Print or Type Only 6�/„p �,0 <br /> /�., C�,,J <br /> �IZNe T I �ti�u2 � /// �'-aJ ..�'�T �S9- �. �� � <br /> Owner � Mailing Address City Zip Phone <br /> z <br /> ��FF h� �i � <br /> Applicant Mailing Address CitY Zip Phone � <br /> �� <br /> m <br /> Describe Proposed Work C��"= �a� � <br /> � .-. .-. <br /> --I �7 <br /> � � <br /> Nm <br /> W m o <br /> Prolect Address(if known) � �� �'v � � � m <br /> Attach four(4)copies of plans for proposed�vork- Draw lo scale and note the following as applicable: � m� <br /> • Property Lines • Centerline of street � �-+ <br /> • Outline and dimensions of eil existing and • Indicate North '� z <br /> c <br /> proposed structures on the Iot � Show any proposed grading changes � _ <br /> • Existing and proposed utilitfes • Show measurements M �+ �+ <br /> � —1 N <br /> < <br /> DO NOT WRITE BELOW THIS LINE '� <br /> oa <br /> PERMIT CONDITIONS -r m <br /> 1. All calls for inspection>hall be made 24 hrs. in advance•phonr. 259-881 5. � _ <br /> m .+ <br /> 2. All work shall be performed in sccordance with this permit and current City ol Everett Design and Consiruction N <br /> 0 <br /> Standards and Specific:ations o r <br /> 3. Ca��location Under�r�untl Service 48 hrs.before you dig.TOLL FREE NUMBER 1•800•424-5555. � c y <br /> mN <br /> O -r r <br /> m <br /> a <br /> a <br /> � � <br /> _ <br /> a <br /> z <br /> � � <br /> x <br /> .. <br /> O y <br /> Z <br /> O <br /> a � <br /> � <br /> m <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> � �jpzy,�y /� �'fL The underei:;ned owner/applicant hereby agrees to hold and save harm- <br /> less ihe Cil�� of Everett from any and all claims lor damages, costs, <br /> expenses. or causes of action that may arise because of installation <br /> and maintenance of the improvement or other right•of-way use hereto <br /> — applied for and further agrees to remove same upon notice from the <br /> Approved lor Construction - Date City and to replace public property damaged thereby. <br /> �'��/� ��.1� /-�- � � ��-_�� p �/ <br /> FINAL INSPECTI Date � / �H/.✓� ! '.Z � "�7 <br /> Approved as Constructed Signature of Applicant � Date <br /> everett PUBLIC WORKS DEPARTMENT WORK AUTHORIZED BY THIS PERMiT MUST BE STARTED WITH�N <br /> 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200 Cedar Street B[ 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: 259-8815 PROJECT OVER 90 DAYS DURATION. <br />