Laserfiche WebLink
Date 5 c��l <br /> Puhbc WorFs Pe�mil v <br /> Application for einy ueo�.• � <br /> �,��-- <br /> PUBI_IC WORKS PERMIT P�����Y,o.�sF�� <br /> TOLiI Fee $—. <br /> LPSS AOPI FP,P Prt�tl J <br /> Print or Type Only Bolanr,e Due s <br /> �en�1�i1�1'�6 C)� l�D h��x /,��� EVP/e tf 9d'�/ -Z59- 7/� s <br /> Ownrr Mailing Address Cit — <br /> Y Z�P Phone <br /> J G1/� <br /> Applicant Mailin9 Address City Zip Phone <br /> Describe Proposed WorM. ._ ��('�,OC�Q�I 'I�P vN�I � ( /i �� i,n�w P�_.� � ,r,�. <br /> Prolect Address(if known) _ �i� I .S Lnn.�G,�i�� � <br /> Altach 'our(4) Copies ol plans for proposed work- Draw to scale and note Ihe tollowing as applicable: � <br /> • Properfy Lines • Centerline of streel � <br /> • Outline and dimensions of all exisling and • Indicate North <br /> proposed structures on the lot � • Show any proposed grading changes <br /> • Existing and prop�sed utilities • Show measurements � <br /> DO NOT WRITE BELOW THIS LINE <br /> PERMIT CONDItIONS O <br /> 1.All calls for inspection shall be made 24 hrs.in advance-phone 259-8810. � <br /> 2.Ail work shall be pertormed in accorde�ce with this permit and current City of Everett Design and Construction <br /> Standards and Specifications. <br /> 3.Call Location Underground Service 48 hrs.betore you dig.TOLL FREE NUMBER 1-$00-424•5555. � <br /> /�/� ��-�� �� / O <br /> y2 <br /> � � z/=B 9 � <br /> � <br /> O <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersi9ned owner/applicanl hereby agrees to hold and save harm- <br /> less the City ol Everett irom any and all claims tor damagas, cosls, <br /> expenses. or causes of ac�ion �hat may arise because of installation <br /> and maintenance of �he improvemen� or other right-ol�way use hereto <br /> Approved for Conslruction pd1e applied for antl further agrees to remove same upon notice Irom the <br /> City and to replace pubfic property damaged thereby. <br /> FINAL INSPECTION p��e <br /> Approved as Constructed Signature ol Applicant Date <br /> everetl PUf3LIC WORKS DEPARTMENT WORK AU?F10RIZED BY THIS PEP.MIT MUST BE STARTED WITHIN <br /> � 3200CetlarSireet 180 OAYS OF DATE PERM17 IS ISSUED AND THEREAFTER IS TO <br /> EveretL WA 98201 BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Phone:259�8810 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER SO DAYS DURATION. <br />