Laserfiche WebLink
� ""I <br /> Date�v`� PubLc Worb Per� <br /> plag.Oopl.+ -- <br /> Application Foi <br /> PUBLIC WORKS PERMIT PUbTotlFeaFoe $ --_ <br /> Lesf Appl Fee Pa10 g <br /> Balance Oue S <br /> Print or Type Only <br /> l� 17 ^'f-i��f� fll I �j ( 1� [�'��P1/I �C I�' �'�-��2�/i.(� <br /> Owner MaJina Atldress City ZiP hone <br /> 1 1 ll <br /> Applicant Mailing Adtlress Ciry Zip Phone <br /> Describe Prcposed Work ���`7't��T c.J—II U_�T�s��T , , r��`���� <br /> - W <br /> Proiect Adtlress(if known) ��/ `s�. Ev�, ��� /v 7�� H <br /> Attach four�4)copies of Plans lor proposed work• Draw to scale and nole the lollowing as app�icable: � <br /> • Property Lines • Centerline of sireet � <br /> • Outline and tlimensions ot all existing and • Indicate Norih <br /> proposed structures on Ihe lot • Show any proposed gratling changes <br /> • Existing and proposed u:ilities • Show measurements � <br /> DO t`IOT WRIT[ BELOW THIS IINE O <br /> PERMIT CONDITIUNS <br /> 1.All cells for inspection shall be made 24 hrs.in advance•phone 259•8810. � <br /> 2.All work shall be pertormed in accordance with this permit and current City of Everett Design and Construction <br /> Standerds and Specifications. <br /> 3.Call Locetion Underground Service 48 hrs.betore you dig.TOLL FREE NUMBER 1•500-424•5555. � <br /> �1��T� r���l . �a �ga � <br /> �=�i� �." <br /> � <br /> � <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned ownedapplicanl hereby agrees to hold and save harm� <br /> less the City of Everelt Irom any and all claims for damages. costs, <br /> ezpenses, or causes ol action tt,3t may arise because ol installation <br /> and maiMenance ot the improvement or other nght-ol�way use he:eto <br /> applied lor and further a9rees lo remove same upon notice irom Ihe <br /> Approved for Construction Dale City and to replace public properly damaged thereby. <br /> FINA� INSPECTION Date <br /> Approved as Constructed Signature of Applicant U2te <br /> WOFK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> everett PUBLICWORKSDEPARTMENT 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER 18 TO <br /> � 3200CedarSlreet BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT A1A1' BE <br /> Evorelt,WA 98201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone:259�8810 PRO.IECT OVER 90 DAYS DURATION. <br />