Laserfiche WebLink
��• . <br /> r�° ,-x. <br /> ir� , 1 <br /> �fi�@�—/ �!' Puoec Wo�ka Perm.{.t _____L//i/ � d <br /> � �a.. <br /> Application For Blap.Depl.• ((�._ �� � <br /> PUBLIC WORKS PERMIT Pu�li�WorkaFee — <br /> Tolel Fee s <br /> leas Appl Fee Pnia S <br /> Balanca Dua S <br /> Print or Type Only <br /> �n�TN�Ji=� �S'f- 5.�.3.� <br /> wn Mailing Address City Zip Phone <br /> �� �,�c_ <br /> Applicant Maiting Address City Zip Phone <br /> Deecribz Proposed Work C—t k7k��v <br /> Froject Adaress(if known) �?�=�� L-- O c. l�� �r. �.f /�'� � <br /> � <br /> Fdtach four(a)�opies ot plans lor proposed work• Draw tc�scale and nole the following as applicable: � <br /> • Property Linas • Centerline of street � <br /> • Outline and dimensions of all uzisting and • Indicate Ncrth <br /> proposed structures on the lot • Show any proposed grading changes <br /> • Ezistino and proposed utilities � Show measurements � <br /> DO NOT WqITE BELOW THIS LINE <br /> PERMIT GONDITIONS O <br /> 1. All calls�or inspection shall be made 24 hrv. in advance-phone 259•881 5. � <br /> 2. All work shail be perlormed in acwrdance with thls permit and current City of Everett Design and Construction <br /> Standards and Specifications. <br /> 3. Call Location Underground Servic��48 hrs. before you dig.TOLL FREE NUMBER 1•800-424•5555. � <br /> /!/O t�UBLiG G�/0.2.�5 PE'•2rn.� �E'qc.i.BEOC//✓�f�0/8�, O <br /> �� <br /> � <br /> Y! <br /> O <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees to hold and s:ive harm- <br /> � less the City ot Everett irom any and all claims lor demages, costs, <br /> expenses, or causes of action thal may arise because of installation <br /> and maintenance of the improvement or other right•ol-way use hereto <br /> applied lor and further agrees to remove sam� upon notice Irom the <br /> Approved lor Consirudion Dale Ciry and to replace public property damaged thereby. <br /> FINAL INSPECTION Date <br /> Approved as Constructed Signature ol Applicant Date <br /> everett PUBLIC WORKS DEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST BF STARTED WITHIN <br /> � 3200 Cedar Street 180 DAYS OF DATE ,�ERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everett, WA 98201 BE DILIGENTLY PURSUED TO COMPLETION.THIS PERMIT MAY BE <br /> Phcne: 259•8815 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAYS DURATION. <br />