Laserfiche WebLink
Date�p D <br />Application For <br />PU�LIC Wc�RKS PERMIT <br />Print or Type Only <br />Applicant <br />Describe Proposed Work <br />Projecl Adtlress (it known) <br />Malling <br />Mailing Address <br />Puoec woiws aei � l <br />eiag oep�.. <br />Pu�bc YJorks Fcc ! ��— <br />To1al Fee S � _�![� <br />Less ApPL Fee Panl S <br />Balanro Duc <br />Z�P Phone <br />Lip <br />Attach lour (4� copies ot plans lor proposed work � Draw to scale antl note the following as applicable: <br />• Property Lines • Centedine olsVeet <br />• Outl'ne and dimensions ol all exis�ing antl • Indicate North <br />GroposeE structures on the lot • Show any proposed gradin�j changes <br />i Existing and proposed utilities • Show measurements <br />PERMIT CONDITIONS <br />1. All calls for ins�ection shall be made 24 hrs. in aCvance - phone 259•88� 0. <br />2. All work shall be peAormed in accordance with ihis permit and currenl City ol Everet� Design and Conslruction <br />Standards and Speci(icalions. <br />;i. Call Localion Underground Service 48 hrs. before you dig. TOLL FREE NUMBER i-800-424•5555. <br />�. �� a�jor�..<<�� � s o�i�P� -�/- 27- £� o <br />ACKNOIYLEDG[td[NT OF CONDITIONS <br />W <br />� <br />_ / <br />� <br />� <br />__ The undersipned ov;ner/aGPlicanl hereby agrees to hold and save harm- <br />Iess the Gty ol Everetl irom any antl all claiRs lor damages, costs. <br />-_ -� � ezpenses. or causes o� action t„ht may arise because o( installation <br />" 4-�6 and maintenance ol the improve ent or other righPohway use hereto <br />�� applied lor and fwthe agrees t remove same upon notice Irom the <br />ir n Date City and�6 replace p Gc pwpe� damaged Ihereby. , <br />✓ = �� <br />Approved as Consirucled <br />�vere�t PUBLIC WORKS DEPARTMENT <br />� 3200 Cedar Street <br />Everelt. W� 98201 <br />Phonr. 259�8810 <br />Y/,.� <br />gnature ol Applicant' "� Datc <br />ORI( AUTHO1�iIZED BY THIS PERMIT MUST BE STAfiT D WITHIN <br />�7b0 UAYS OF DATE PERMIT IS ISSUED AND iHEREAFTER IS TO <br />BE DILIGENTLY PUFSUED TO COMPLETION. THIS PERMIT MAV �E <br />CANCELLED BY THE CITY UPON ANt STOPPAGE Of 6VORK pN THIS <br />PROJECT OVER 90 DAYS DUR�TIOI'. <br />