Laserfiche WebLink
t <br /> � �j �� •- . - , <br /> �� Pu01¢WaihsPermi ����/�`— <br /> �8te 1� <br /> Application For ema.oao�.• <br /> PUBLIC WORKS PERMIT PuoTolalFeaFee s — <br /> �ess nou�.Fec vem $ <br /> Daia�ccouc S c•2op0 <br /> Print or Type Only <br /> �atr�-��: �l� <br /> Owner Mailing Address Gty Zip Phone <br /> �c�..��(c�r��n� �3 ���i� � �'�nds ����o _ <br /> Applicant Madmg Address City Zip Phone <br /> Describe Proposed Work ��"�� } � ^�� l �=� �r� c��A �O` ^F� <br /> - W <br /> Prolect Address Iif known) ��7— �C)lvE�nOOk' LN. � <br /> Attach lour(4�copies of plans lor proposed worh-Draw to scale and nole the tollowing as applicable: � <br /> • Property Lines • Centerline ol s�ree� � <br /> • Outline and dimensions ot all existing and • Indicate North <br /> proposed structures on the lot • Show any proposed grading changes <br /> • Existing and proposed u�ilities • Show measuremenls � <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 1.All calls for inspection shall be made 24 hrs.in advance•phone 259•881 O. � <br /> 2.All work shall be peAormed in accordance with this permit and current City o(Everett Design and Construction <br /> Stendords and Specifications. � <br /> 3.Cell Location Underground Service 48 hrs.betore you dig.TOIL FREE NUMBER 1-8C0-424•5555. � <br /> O <br /> � <br /> � <br /> O <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> � 1 ne undersigned ovwner/applicaN hereby agrees to hold and save harm- <br /> less the City of Everelt Irom any and all claims lor dam2ges, costs, <br /> <�� / � � / � expenses, or causes of action that may arise because of inslallation <br /> fJ f�7��• ��C�/ 8o and maintenance ol the imPrevement or othm righDobway use hereto <br /> A roved for Cons�ion Date applie and lurther agiees to remove same upon notice irom the <br /> PP � City nd to eplace pubGc property damaged thereby. <br /> �'�/ -�'/'l'�'F ` � 88 <br /> FINAL INSPECTION Date <br /> Approved as Constructed ure ol Applicanl ate <br /> everett PUBLICWORKSDEPARTMENT WORK AUTHORIZED BY THIS ERMIT MUST BE STARTED WITHIN <br /> 180 DAYS OF DATE PERMIT �S ISSUED AND THEREAFTER IS TO <br /> � 3200 Ceder Sireet BE DILIGENTLY PURSUED 70 GGMPLETION. THIS PEtiMiT MAY BE <br /> Everett,WA 98201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone:259•8810 PROJECT OVER 90 DAYS DUr7ATION. <br />