Laserfiche WebLink
/ � ^ <br /> �'j�8� pud2 Wmrke Pe m�t• <br /> Application For e��o o�o�.. �,j�` / •jti�� / <br /> PUBLIC WORKS PIERMIT P��I•cWorkeFea 5 <br /> Tolal Fee <br /> Leea ROPI.Fee PaC S <br /> Print or Type Only e��a��,o�, a <br /> \�TFcJ�' �IPC��lAN � � ��� J AC/�'Jd� / )Prf' � �c�"o1v.� . �-�.3�7 <br /> Owner �,iailing Address City Zip Phcne <br /> �J�Am �- <br /> Applicant Mailing Address Ci�y 2ip Fhone <br /> Describe Proposetl Workn c�oL�n� V7 FadC'�iJ ' 7JP`/�(�C��n . L) ( 1 �! I H �C QOI/t � <br /> i� i-'+i c F � <br /> � <br /> Project Address(il known) _ � � <br /> Atlach tow �4)copies ol plans for proposed work- Draw to scale and no�e ihe following as applicable: e <br /> r Property Lines • Centerline ef street /� <br /> e Outli��e and dimensions of all existing and • Indicate North V, <br /> propnsed structures un the lot • Show any p;oposed qrading changes <br /> i Existing and proGosed utilities • Show measurements � <br /> �� <br /> DO NOT WRITE BELOW THIS LINE <br /> PERMITCONDITIONS ' � <br /> L All calls lor inspection shall be made 24 hrs. in advance- phone 259•881 5. � <br /> 2. All work shall Ue per(ormed in accordance wi�h lhis Germit and current City cl Everett Design and Consiruction <br /> Standa�ds and Specifications. <br /> 3. Call Location Unde�9round Service 48 hrs. before you diq. TOLL FREE NUMEER 1-800•4^c4•5555. � <br /> � <br /> k`� I/ (,� <br /> ��� c f i <br /> Pp����� ���� �' � <br /> ��� � cn <br /> �r � <br /> ��� N ' <br /> - � �'�'� . �`/ �- <br /> � 5 <br /> ACKNOWLEDGEMENT GF CONDITIONS <br /> The undersigned owner/applicant hereby agreec to hold and save harm- <br /> less ihe City ot tverett Irom any anC all claims lor dsma9es, cosls, <br /> expensas, or causes of action that may arise 6ecause of installation <br /> and maiNenance ol the improvement or other right�ol-way use hereto <br /> applied for and luriher ayrees to ramove same upon notice irere the <br /> Approved for Constructien Date Cily and to replace public property damaged thereby. <br /> FINAL INSpECTION Date <br /> Approved as Cons�rucled Siynature of Applicant Date <br /> everett PUBLIC WORKS DEPARTMENT WGRK AUTHOR12ED BY THIS PERMI7 MUST 8E STARTED WITHIN <br /> � 3200 Cedar Street 7B0 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTEH IS TO <br /> Everett, WA 9�201 BE DILIGENTLY PURSUED TO CUtvMPLETIOPI. THIS PFRMIT MAY BE <br /> Phone�. 259�8815 CANCELLED B`!THF CITY UPON ANY STOPPAGE nF�vnqK ON (HIS <br /> PROJECT OVER 50 DAY"S UUFATION. <br />