Laserfiche WebLink
PubM1c 1Vo'A5 Pv�m�� • <br /> Date�C'��.cl/�9 �' �,� � - <br /> uinn o�ci . _�l-� L��.�_. <br /> Applicalion For <br /> PUBLIC WQRK� PERMIT P°°to,`w�F��"` S <br /> Less Appl.Feo PniO $ - <br /> Balanr.c Dun S <br /> Print or Type Only <br /> � NAdf'�r;✓ ��`�L u��� _Z��i'I �j�. l�. i 1Y'2CL� �.Li/In�//Yr.� l�� 7�{L��6 77Y—Q7rYrQ' <br /> J�(l <br /> Owner Matlm9 Address City / 7.ip Phone <br /> �p* P Clt Zin Phone <br /> Appllcant Mailing Address Y <br /> �/ !T �/4 /ilu � 17`l L'/� �-"!�r ' <br /> Desc�ibe f'roposed Work �P 41 R N7 I M � <br /> / W <br /> Proiect Address lif knownl 'r/ S� � iA fP/T �� I�1JAI� � <br /> Attach tour(4) coUies ol plans for proposed work- Draw to scale and note the lollowin�as applicable: � <br /> � Property Lines • CenlerBne ot sireet � <br /> • Out�ine and dimensions of all existing and • Indicale Nor�h <br /> pioposed structures on the lot • Show ary proposed grading changes <br /> • Existing and proposed utili�ies • S��ow measurements M <br /> W <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•8810. <br /> 2.All work shall be performed in accordance with this permit and current City of Everetl Design and Construction <br /> Standards and Specilications. <br /> 3.Call Location Underground Service 49 h•s.before you tlig.TOLL FREE NUMBER 1-800•424-5555. � <br /> /.l!� ,�: ,�t : �� O <br /> t� . , J����� N <br /> =�s <br /> ��� �)� O <br /> a <br /> �CKNOWLEDGEMENT OF COMDITIONS <br /> The undersi�jned owneUapphcanl hcreby agrees to hold and save harm- <br /> less Ihe City ot Everelt Irom any anA all claims lor damages, cosis. <br /> exUenses, or causes of action that may arise because ol installution <br /> and maiNenance ol the improvemenl or other right-ol�way use herelo <br /> applied lur and further agrees lo remove same upon notice Irom Ihe <br /> Approved lor Construdion Date City and to replace pubGc properry dama9ed Ihereby. <br /> FINAL INSPECTION Date Date <br /> Approved as Consiwcled Signature ol Applicanl <br /> WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> everett PUBLICWOPKSDEPARTMENT 180 DAYS O� DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200CedarStree� BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Evcrett,WA 98201 CANCELLED 6Y 7HE C�TY UPON ANY STOPFAGE OF WORK ON THIS <br /> Phone:259�8810 PROJECT OVER 90 DAYS DURATION. <br />