Laserfiche WebLink
Date 2,_2-2�'�' � a��i��w�„�s a�,���i,r / <br /> Bi�n Dept .—___L��— �/_�fUe�� <br /> Application For j - <br /> PUBLYC WORKS PERi�lIIT �ubToteliueF"e s --_ <br /> LP.55 AOPI.F¢p P3itl 5 <br /> Print or Type Only �'"�Ce❑Ye s _ <br /> D� rrP iI S,M, t� I 40 ! �.'o.�� �4vn_ 9�ac I 339-�5y�1 <br /> Owner Mailin9 Address' City 2ip phone <br /> Sca m e� <br /> Appli:an! Mailing Address City Zip phone <br /> DescribeProposedWark _���yJttm�l)��� n����F�-� ����1(�tlp�tl��� <br /> r rrp_,,��N � <br /> �� ��P.1 <br /> �— <br /> ��I — W <br /> Prolecl Address(if known) �'�� J T /9 /e. L <br /> � <br /> Attach fow(4)copies ol plans lor proposed work- Draw to scale and note the�ollowing as applicable: � <br /> • Property Lines • Centerline of street y� <br /> • Ou!line and dimensicns ol all existing and • Indicate North V, <br /> proposed structures on�he lot • Show any proposed grading changes <br /> • Existing and proposed utiliLes • Show measurements � <br /> DO NOT WF�II"E BELOW TNIS LINE O <br /> PERMIT CONDITIONS <br /> 7.All calis for inspedion shall be made 24 hrs.in advance-phone 25�9•8810. � <br /> 2.All work shall be performetl in accordance with�his permil and current City of EvereR Design and Construdion <br /> Standards and Specifications. <br /> 3.Call Location Underground Sen�ice 48 hrs.6efore you dig.TOLL FREE NUMBER�•800•424•5Pi55. � <br /> O <br /> ���Z/C Lc.�O/-'/�S' ��s;?�n:T .�✓07� ����/�ii/'�� • � <br /> �/L�� � <br /> ! � � <br /> a <br /> ACKNOWL[DGEMENT GF CONDIiIONS <br /> The undersigneU owner/applicant hereby agrees to hold a�d savn'iarm- <br /> less the City of Everelt Irom any and all claims for da. �ages. costs, <br /> expenses. or causes of action Ihat may arise because ol installation <br /> and maintenance of the improvemenl or other righbol-m�ay use hcrete <br /> app!ied !or and lurther agrees to remove same upon notice fwm ihe <br /> Approved lor Construc�ion Date Ciry and to replace pu6lic properry damsged th�reby. <br /> FINAL INSPECTION Date <br /> Approved as Constructed Signature of Applicant Dale <br /> evemlt PUBLIC WOPKS DEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> � 3200CedarSlreet 780 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everett,WA 98201 BE DILIGENTLY PURSUED TO COMPLETION. THIS FERMIT MAY BF <br /> Phone:259�8810 CANCELLED BV THE CITY UPON ANY STOPPAGE OF l"JORK ON THIS <br /> PROJECT OV[R 90 DAYS DURATIUN. <br />