Laserfiche WebLink
NPE OR P91NT ONLY <br />Applice�n For <br />PUBLIC WORKS PERMIT <br />� <br />PUBLIC WORK�EPARTMENT <br />3200 Ce�r Sireet <br />Everetl, WA 982� 259-8810 <br />g � � <br />s <br />M O O <br />N � � <br />'G/lA/ '2/_/'i� �7=�I�JI /�J�V <br />� iS - -- CiTy <br />Describe Proposed Work /t�D✓E CENC C I(/ �`i <br />�brrf o� sT,��c T-_ Ann 1' Fi <br />r <br />PROJECT ADDRESS (if known) <br />oate �d- 3 - `�/ % / <br />Public Works Permi� N 3%% <br />Bullding Pnrmit M <br />O <br />Public Works Fee $ � C� �� <br />�K <br />qszoi 33�-qt25 <br />Phone Mty f,LL Z:Oo� <br />� r � D r��l <br />Attach four (4) copies of plans for proposed work - Draw to sca�e and note the following if applicable: <br />•Property Lines `Oi�tline and dimensions of all existing and proposed structures on the lot •Existing and proposed utilitles <br />•Centerline of st2et •Indicate North •Show any proposed grading changes •Show measurements <br />PERMIT CONDITIONS: <br />1. All calls for inspection shall be made 24 hours in advance - phone 259-8810. <br />2. All work shall be performed in accordance with this permit and current City of Everett Design and <br />Construction Standards and Specifications. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800-424-5555. <br />� <br />S <br />�,��� �o dF ,�4� i�;5�f � �z ";.� �� �y <br />,�',y�rf- -o�= a.�a�/ <br />�n hG� ��OC� ��4li�QSt C-/lahh�� <br />� <br />(. ��� c��y s�i-���5 cC«<.� ��f �(C fi;r�.r <br />� <br />O <br />/�� <br />V♦ <br />O <br />a <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undersigned owner/applicant hereby agrees to hold and save hartnless <br />the City o� Everett irom any and all claims for dam2ges, costs, expenses, or <br />causes of action that may arise because of installation and maintenance of <br />theimprovamentorotherrignFof-wayuseheretoappliedlorr•� funheragrees <br />to removo same upon notice trom the City and to repl,. .. ,,ublic property <br />damaged thereby. <br />�y`��r �t��Gd� �0�7 �4(P <br />oignature of Applicant � Dal�� <br />WOHK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN 180 DAYS OF UATE PERMIT IS ISSUED AND THEREAFTER IS TO BE DILIGENTLY PURSUED TO <br />COMPLETION. THIS PERMIT MAY BE CANCELLED BY THE CI1Y UPON ANY STOPPAGE OF WORK ON THIS PROJECT OVER 90 DAYS DURATION. <br />