Laserfiche WebLink
<'. <br /> �. <br /> �et@ • Pu�lic Worb Pm�t• _ �� <br /> siaa o.o��• � <br /> App�ication For --�� <br /> PUBLIC WORKS �ERMIT P�o;o,WorkaFee S <br /> Lem�pD�Fee PHG S <br /> Print or Type Only s.�.��a r�a s 2�--�— <br /> l �' � �UiJ_ <br /> —�wner MaiHng Adc'ress City Zip Phone <br /> ��� �A n�sa� ���,:— ,C�; 5��0 3 �.s-9 - ���s� <br /> Applicent Malling Adtlress City Zip Phone <br /> Descdbe Proposed Work �. `�-�-� ��^ � <br /> � <br /> /G/.3 - W <br /> /��p LoT' "`3 � <br /> Projcct Address(il known) �L� — EvGEh�c�'e �i(� cREsrc,�ooa <br /> Attach lour(4) copies of plans for proposed work• Drew ta scale ar.d nole the lollowing as applicable: � <br /> • Property LinFs • Centerline ol sdeet � <br /> • Outline�nd dimensions uf all existing and • Indicate North <br /> pn,posed structu�es on the lot • Show any proposed grading changes <br /> • Ea�sting and proposed utilities � • Show measurements � <br /> ��� <br /> DO NOT WRIT[Bf:LOW THIS 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 pe�mil ^^d:urre:it Ciry ol Everett Design and Construction <br /> tandards and Specilications <br /> I Location Underground Service 48 hrs be�ore you dig.TOLL FREE NUMBER 1•800•424-5555. � <br /> I� <br /> O <br /> H <br /> � <br /> O <br /> a <br /> � ACKNOWLEDGEMENT OF CONDITIONS <br /> Q The unders�gned ownar/applicaM hereby agrees to hold and save harm- <br /> less the CitY of Everett irom any and all claims lor damages, costs, <br /> / expenses, or causes of action that may arise because of insta'lation <br /> �-'�k�""_' p O _ ...��Z/8�v and maintenance of the improvement or other right•�'-way use hereto <br /> i� d70sii►y <br /> applied for and further agrees to remove same upon notice from the <br /> � Approved for C�nstruction � / �a�e City and to repiace public rQpeny damaged thereby. <br /> G��C/ .�� -�� / � I � <br /> FINALIN ION � Date '�"_—"� �' �— `� —� �'���' <br /> Appro d as Constructed Signature of Applicant Date <br /> everett PUBLIC WORKS DEPARTMENT WORK AUTHORIZED BY THi� PERMIT MUST BE STAFTED WITHIN <br /> � 180 OAYS OF �ATE PERMIT IS ISSUED AND THEREAFfER IS TO <br /> 3200 Cedar Street BE OILIGENTLY PURSUED TO COMPLETION. THI:' PERMI7 MAY Bt <br /> Everett WA 98201 CANCELLFD BY THE CITY UPON ANY STOPPAGL OF WORK ON THIS <br /> Phone: 259•8815 PROJECT OVER 90 DAYS DURATION. <br />