Laserfiche WebLink
r <br /> .I <br /> Date�� � _�y"' �, '—� <br /> Ll(LO u P�e���wo�w�P�,m,�. <br /> Application For eia9 o�oi.» _ <br /> PUBLIC WORKS PERM!i PuoTotTFeoFee s <br /> Less ApPL Fee PaiO S <br /> Print or Type Only ea�,��eo�� S <br /> �� C��l� ��� �'�>>� V��h �a ��P� q�� � <br /> Owner Mailing Address i�y Zip Phone <br /> r ��"�/'.--� <br /> �-I�� C�.P�$-�a�-r- � a�i�( ��- �_ � � ��J <br /> Applicant Mailing Address City Zip Phone <br /> Describe Proposed Work y K , , V -' �_ � � � �� <br /> :��� . W <br /> Project AAdress(if known) � <br /> Attach four(4) copies of plans for pwposed work- Draw to scale and note the tollowi�g as applicable: � <br /> ! Property Lines • Centerline ol street /� <br /> • Outline and dimensions of all existing and • Indicate North V� <br /> proposed structures on the IoI � Show zny proposed grading changes <br /> • Existing and proposed utilities • Show measurements � <br /> � DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> i.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 ot Everett Design and Conslruction <br /> Standards and Specifications. <br /> 3 Call Location Underground Service 48 hrs.be(ore�ou dig.TOLL FREE NUMBER 1-800-424-5555. � <br /> r�c� ��I�.� O <br /> ���� 8���8 ~ <br /> � <br /> O <br /> a <br /> ACKNOWLEDGEMENT Of CONDITIONS <br /> The undersigned owner/apPlican�hereby a9rees to hold and save harm- <br /> less the Citp of Everetl Irom any and all claims tor damages, costs. <br /> expenses, cr causes ol aclion that may arise because of installation <br /> and maintenance ol ihe improvement or other righbof-way use hereto <br /> applied for and furlher agrees lo remove same upon notice from Ihe <br /> Approved for Construction Date City and to replace public properry damac�ed thereby. <br /> FINAL INSPECTION Dale <br /> Approved as Construc�ed Signature o�Applicant Date <br /> everett PUBLIC WORKS DEPARTMENT WORK AUTHORIZED BY THIS PERIv11T MUST BE STARTED WITHIN <br /> � 3200CedarSlreet 780 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everett,WA98201 BE DILIGENTLY PURSUED TC COMPL[TION.THIS PERMIT MAY BE <br /> Phane.259�8810 ChNCELLED 8Y THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAYS UURATIO�. <br />