Laserfiche WebLink
� �Date� <br />Ao,�lication For <br />PUBLIC WLIRKS P'EFiNiIT <br />Print or Ty�e Only <br />° Owne-�I�r� <br />.�_J__� �,��- <br />APphcant <br />Describe Propased Work <br />Froject Address I�f known) <br />Mailing Addres5 <br />�,.,�����,��.;�.., � %�, c�--�` <br />ein:i o��ni , _ — �1 �_I_. <br />Pe1.L[WothSfeC � �� . . <br />TOLtI Fee S _ _ <br />Less Ap01 Fee VaiO S <br />�alance Dun $ __ <br />C 7�� <br />Ci�y <br />� <br />z�n <br />Attach four (4) copies of plans for proposed work - Drevi io scaie and note the following a; apP�ica� <br />• Property ! ines • Centerlme of street <br />• Gutline and dimensir,ns of all existinr_, and • Indicale North <br />pioposetl strudu�es on the lot • Show any proposed grading changes <br />• E4sting and proposed utilities • Show measuremenis <br />I�@IP <br />PERMIT CONDITIONS <br />!. �>II calls for inspection shall be made 24 hrs. in advance • phone 259•$810. <br />2. All work shall be?erformed in accordance wilh ihis permit and cu«ent City of Everelt Design 2nd Construction <br />Standards and �oe�ifications. <br />3. Call Location Uiderground Service 48 hrs. 6efore you dig. TOLL FREE NUMBER 1-800•424•5555. <br />� � . � � LG'c .-� - j;� s. ,,.1 / � , .�,. <br />Approved for G�nstruction <br />FINAL INSPECTIOfI <br />Apowved as Con=_vuc�etl <br />everett PUBLICVdORKSDEPARTMENT <br />� 3200CedarStreet <br />Everett, WA 98201 <br />Pt�one: 259�8810 <br />Date <br />Dale <br />� ,. ... �•/ �_�� _ �� <br />% _ i� i� <br />�7 <br />� <br />� <br />.1CKNOYVLEDGEMENT OF CONDITIONS <br />The undc.rsi9ned owneUapplicant hereby agrees to hold and save harm� <br />Ie;s the City of Everett Irom any and all claims lor damages, costs. <br />e<penses, or causes of action that may a�ise because of installation <br />:,nd mainterance of ihe improvement or other righhoFway use hereto <br />applied br and furiher agrees to remove same upon notice Irom the <br />City and to replace public property damaged thereby. <br />Signature ol Applicant Date <br />WORK AUTHORIZED BY THIS PERMI7 MUST BE STARTED WITV{IN <br />180 DAYS OF DATE PERMIT IS I:..iUED AND THEREAFTER IS TO <br />BE D!LIGENTLY PURSUED TO COMPLFTION. THIS PERA9IT �dAY BE <br />CANCELLED BY THE CITY UPON AN'�' STOPPAGE OF WORK ON 7HIS <br />PROJFCT OVER y0 DA'IS DURATION. <br />