Laserfiche WebLink
7 l�—� <br />Date --� «.� <br />Applicali0n For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />Applicant <br />Describe Proposed Wcrk <br />Praject Address �it known� <br />PuoLc WorFs Permil � �vl • � / � <br />5ioe oeo�. • _ <br />Fuoimwor.s�oa g <br />TotN Fee <br />Less Aoo� Fee Pala $ <br />Balance Oue S ��� <br />o PAl 2�3C: � ( Ic.�c� j�h/� L-�4}'� c.�,'V-� <br />Address <br />Mailing Address <br />�v <br />o�y z �� <br />j'��� �-� `� . <br />Atlach lour l4) copies ol plans br preposed work - Draw to scale and note the lollowing as applicable <br />• Propeny Lines • Genterline uf stree� <br />• Outline and dimensions ol all existing and • Indicate Norih <br />proposed siructures on Ihe lo' f Show any proposed �rading changes <br />• Existing and proposed utilities • Show measurements <br />Tf11S LINE <br />PERMIT CONDITIONS <br />7. All calls tor inspection shall be made 24 hrs. i ance - phone • 810. <br />2. All work shall be peAormed in accor e with his permit current City of Evereit Design ar <br />Standa�ds and Specifications. <br />3. Call Location Undergroun rv�ce 48 hrs. hefo u dig. TO�REE NUMBER 8�0•42� <br />� �' I�./ �� �{�Sd'e e / Sr�S,� S <br />�/ �-j n " �Gt <br />���`�`'�' ���n5 ��! ����1 p� � / <br />� <br />3� <br />� ���, , <br />y�r'� �� Q� 5�5, <br />��� a.����e� � <br />�t �`' Sk �'t1( r,�', ��,,A <br />e <br />��,��II�- 5����y � <br />,��� �'� <br />lor Construction <br />s <br />Date <br />FINAL INSPECTION Date <br />Approved as Construc�ed <br />everett PUBLIC WORhS �EPARTMENT <br />� 3200 Cedar Sireet <br />Everett, WA 90201 <br />Phone', 259-C810 <br />ai,��c <br />Construction <br />33 ie �/; <br />� <br />�/,., �; � <br />Z <br />O <br />♦�^ <br />V♦ <br />I�� a. <br />�� /3o�y�� �— <br />�°( <br />�� ACKNOWLEUGEMENT OF CONDITIONS <br />The undersic�ned ownedapplicant here6y agrees ic ho�d and save harm- <br />less the City ol Everetl Irom any and all claims lor damayes, cosls. <br />expenses, or causes ol aclion that may arise because of mstallation <br />and maintenance ol the improvement or other ri9hboFway use hereto <br />applied lor and lurther agrees to remove same upon notice irom thc <br />Ci�y and to replace public property damaged thereby. <br />! l/' 7 d1 %(�� .3_ 1- �> . <br />Si3nature of Applica�t Date <br />WORK A�JTHORIZED BY THIS PE�7MIT h1U5T BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED �ND THEREAFT[F IS TO <br />BE DILIGENTLY PURSUED TO COA1I'L!'iION. il{IS PERI.iIT t,fA\' �[ <br />CANCELIED BY THE CITY UPON �1�d� S10PPAGE nF �qORK O�d 7H15 <br />PROJ[CT OV[R 90 DC.YS DURATIOW. <br />