Laserfiche WebLink
- - - ... - <br /> Date�p(�(J[� a � PuOLc Works Permi�• <br /> ' [ �ApplicationFor BItlg.Dept.+ r� 7 /,S-_?�/ <br /> PUBLIC WORKS PERMIT PUEIkWorksFeo — <br /> ,o�,�Fee s <br /> � �ess noa�Fee aaia S <br /> Print or Type Only BalnnceDua a <br /> L Owne ���"'r!, � 89/Maihn Add Ps�n�� '/P/Q �T lOo�(l`7 3.5����7 � <br /> 9 Ciy Zip Phone <br /> l� ol 3sa�1 %Z c„� ,�ti ��iA�P � G��/ z5�` />>7 <br /> ah LuK <br /> Apphcant Mailing Address City Zip P one <br /> � (_/ � <br /> Describe Proposed Work �1 1 �X f� (X(��J��i�_������ <br /> � <br /> Prolect Address(it known) � J � <br /> Attach four(4) copies of plans for proposed work• Oraw to scale and note tlie lollowing as applicable: � <br /> • Prope�ty Lines � Centedine of street � <br /> • Outline and dimensions of all existing and • Indicate North <br /> proposed structures on the lot • Show any proposed grading changes <br /> • Existing and proposed utilities • Show measurements � <br /> DO NOT WRITE BELOW THIS LINE <br /> PERMIT CONDITIONS O <br /> 1. All calls lor inspection shall be made 24 hrs. in advance• phone 2:59•881 5. � <br /> 2. All work shall be performed in accordance with lhis permit and current City of Everett Design and Construction <br /> Standards and Specifications. <br /> 3. Cal�Location Underground Service 48 hrs. bctore you dig.TOLL FREE NUMBER 1•800•424-5555. � <br /> �'UC l.�JO.C'.�S' fE�ir�iT .tJOT �EEqv/•ee0 ��o'o2S-87 <br /> %'�'"� O <br /> � <br /> � <br /> O <br /> a <br /> ACKNOWLEDGFMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby ag�ees lo hold and�ave harm- <br /> less ihe City oi Everett from any and all claims for damages, costs, <br /> expenses, or causes of action that may arise hecause of instalfation <br /> and maintenance ol the improvement or other right-ol-way use hereto <br /> Approved for Construction applied (or and turiher agrees to remove same upon notice Irom the <br /> Date City and to repiace public property damaged ihereby. <br /> FINAL IN3PECTION Date <br /> Approved as Constructer� Signature of Applicant Date <br /> everett PUBLIC WORKS DEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> � 3200CedarStreet 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everett,WA 98201 BE DILIGENTLY PURSU[D TO COMPLETION. THIS PERMIT MAY BE <br /> Phone: 259•8815 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAYS DURATION. <br />