Laserfiche WebLink
�I <br />�i��� <br />,UAx <br />C H <br />� ��+.m <br />Fi y,3 <br />y a' H <br />'C C] <br />H� <br />� H� <br />H V C <br />� O� <br />HG <br />O H <br />� c] C7 <br />H^ LT7 C <br />M, V � <br />ryz <br />�y C�/� y <br />Q H <br />o t� cn <br />��� <br />HO� <br />'�, s� <br />� d. <br />�� �� <br />�� <br />�m w► <br />as ' <br />��;4 i <br />- .��.. <br />' �� � �Z—��-� �� <br />Date���C� TO POSiING---��,7„�.� <br />qppliwtion For <br />pU�LIC WORKS PERMIT <br />Print or Type Gnly <br />Mailing <br />LlN <br />Describe Proposed Wor;c __---�+� <br />(3 <br />Giry <br />��v <br />/ <br />���/ i i � — <br />Pu�l¢ WorMs Permil •/� �J 7 � <br />BI00. De��. � _�1�.�.—F%+=�"'"/^� <br />Puolm Wo�b Fee g <br />iotal Fee <br />Le.s % OPI. FeE PaiO $ <br />5 � L� <br />oain�ur oue <br />�3�/ - <'��a <br />✓' <br />-� Ic5 �oE�c� ��oc,� P,��'> <br />Pro�ec� Address lif known� <br />AUach four 1�1 copies o� P�ans (or proposed work - �ra�v to scale and note � Ce°,,°Wine a� appesahic. <br />� Proper;y Lines � I� :ic:� e North <br />• Outli:�e anA dimensions ol all exisi�ny antl e��.,�,.1• �ny propo,ed gradir. changes <br />proF�sed stmctures on the lot � SP,o�� m�asuremen�s <br />f Eaisling antl pwPosed uliliLes <br />. __� — _—�as�v���nr�saae <br />• <br />PERMIT CONDITIONS <br />t. All calls tor inspection shall be made 24 hrs. in advance � ohona 259-3810. <br />7.. All vrork shall be pedormed in accortlance with Ihis permn snd cnrtent Ciry ot Everetl Ce.��.i9n rnd Cnn�lructior. <br />Standards and Speciliwtions. <br />5. Call Location Underground Service 48 hrs. before you ai9. TOLL FREE NUMBER 1•80Q•42-4•7S�o• <br />�� <br />�cC�ti r11 �c�� <br />Approvetl Ior Cons f � <br />FINAL INSPI <br />qppravetl as <br />everett <br />� <br />i= ��� ����� <br />�_. /, /U� `IJ <br />L- <br />Date <br />FUBUC N'JRKS OEPARTMENT <br />3200 Cetl:�r Slreet <br />Everelt, VJA 9920� <br />Phnna 259-B�1C <br />ACKNOWLEDGEMENT OF CONDITIONS <br />Th�a undersigned owner/aoplican� here�y agrees lo hold and save harm� <br />le:s �ne Ciry of Fven:tl from any ard all ciaims lor daniages, costs, <br />expen,es. �n ceuses of action that may arise because of installation <br />�nd mainle������e o� �he improv�meN or olher ri9h1-ohway use hereto <br />C �yI'and'oo f�rlace`publ �JPeo�ier�y,da nayed hereby,n ro�lce ��om Ihe <br />5�a(urc of A p�icant � �f `���� <br />WORK AUTHORIZED BY THIS PERWIT MUST BE STARTEU WITHIN <br />180 DAY3 OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERM��T D.1AY BE <br />CANCELLE� FY THE CITY UPON ANY STOPPAGE OF WOFK ON THIS <br />PROJ[GT OVER 90 UAlS DURATION. <br />61 <br />