Laserfiche WebLink
-� -� <br /> Date - � a�o���wo,ksPa,m��„ <br /> Application For em� o��i.. 9__7 �_i�F�i <br /> PUBLIC WORKS PERMIT P°°4o,aFeeFeO S _ <br /> Less PppL Fee PaiC S <br /> Balanca0ue $ <br /> Print or Type Only <br /> � -i ' r 'r �, -, _ - _-• � -� — '' j <br /> �-��.,;' �i=,_.,z,> > � _ 1 %/;��/" � �/'� _ '-/-- ��i i .I- _ - <br /> Owner ' Mailing Address Ciry Zip Phone <br /> , <br /> ,;,^- .�� C� . <br /> Applicant Mailing Address Ci�y Zip Phone <br /> i/i . ,� :,71� _ __�i it �,. i , _- `� , <br /> Describe Proposed Work �— <br /> W <br /> Project Address(il known) � /-' "' �� ' � <br /> Altach four(4) copies of plans for proposed work-Draw to scale and note the tollowing as applicable: � <br /> • Property Lines . • Centerline ol street /A <br /> • Outline and dimensions of all existing and • Indicate North V� <br /> proposed struclures on the lot • Show 3ny proposed grading changes <br /> • Existing and proposed utilities • Show measuremenis � <br /> DO NOT WRITE EiELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 7. All calls for inspeclion shall be made 24 hrs. in advance- phone 259•8$1 5. ^ <br /> 2. All work shall be performed in accordance with this p�armit and current City of Everett Design and Consiruclion ♦ <br /> Standards and Specifications. <br /> 3. Call Location Underground Servics 48 hrs. before you dig.TOLL FREE NUMBER 7-500•424•5555. � <br /> ��i�GJG LrJn2/CS %�F,e��i �✓oi ,�E�vi�'co 5�/7�87 O <br /> ��� N <br /> � <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersic�ned owner/applicant hereby agrees to hold and save harm- <br /> Iess ihe City of Everett trom any and all claims lor damages, costs, <br /> expenses, or causes of aclion that may arise because ot inslallation <br /> and maintenanCe of ihe improvement or other righl•ol-way use hereto <br /> _ applied for and further agrees lo remove same upon nolice Irom the <br /> Approved fnr Conslruclion Date City and to replace public properry damaged ihereby. <br /> FINAL INSPECTION Date <br /> Approved as Constructed Signature of Applicant Date <br /> everelt PUBLIC WORKS DEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> 180 DAYS OF DATE PERMIT IS ISSUED AND TfiEREAFTER IS l'O <br /> � 3200 Cedar Street BE DILIGENTLV PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Everett,WA 96201 CANCELLED BY THE GTV UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone: 259�8815 PROJECT vVtR 90 DAYS DURATION. <br />