Laserfiche WebLink
� <br />'fYPE OR PRR�:T ONLY <br />Applicant <br />Appliwtion For �� ^�a STI N G <br />PUBLIC WORKS PERMIT <br />PUBLIC WORKS DEPARTMENT <br />3200 Cedar Sireet <br />Everett, WA 98201 259-8810 <br />SMA �`2 ��IG (_ ` <br />SEVA 9(�`�JZ/ . . <br />� <br />!�, g(,�3 �a�vi%u�e���, <br />iiling Address o: ���. ��; �;� City <br />o.:r _. <br />"� �, ;., ..� <br />� � �i?;�' <br />iiling Address ` City <br />AUG 0 4 �997 <br />/ <br />Date i/— z i— 9� � <br />Public Works Permit N __���73N <br />P�;;:ting ?ermit # <br />0 <br />Pubiic Works Fee S, 2 2� � <br />f3 P <br />��. , <br />SS 36 6 <br />�G - 355 3d6 <br />Describe Proposed Work _ ����`�f�r� LtiliS�c' �,�, c ��i, � ' <br />/-�, 400 C.(� of Bc�ri'oG✓�zcf /�"%�fEriaL r�i� C'�r�5����� d•:F <br />PROJECT ADDRESS (it known) _O�%3 �Q Ui wc <br />Attach iour (4) copies of plans for proposed work - Draw to scale and note the tollowing if applicable: <br />•Pmperty Lines •Outline and dimensions of all existing and preposed stmctures on the lot 'Existing and prcposed utilities <br />•Centrdine of street 'Indicate Norih •Show any proposed grading changes •Show measuremenis <br />DO NOT WRITE BELOW THIS �IME <br />PERMIT CONDITIONS: <br />1. All calls for inspection shall be made 24 houi, in advanca - phone 259-8810. <br />2. All work shall be performed in accordance with this permit and current City of Everett Design and <br />Construction Standards and Soecifications. <br />3. Cail Location Underground Service 48 h�rs. before you dig. TOLL FREE NUMBER 1-800-424-5555. <br />4 T/�� T� Qr�� ex�'���o:� f'acrs o�'�5� w4sf> <br />S�eray� �on.id LuilC �c S�_ded .n o.-,ass L�c <br />_ ,� <br />ih,��ini�e Cr�osioi� und 7`� S�o 6i1��^ t/i�� d,�c , <br />G(/Ois� SiIaLC .G�e c��s�:+ �=�' /1'IS- .i f�Z � /nu:,.�o.rd <br />dy �l ;.� c_,r. <br />. �`,.,.•X� ' PL n �i��' f/� <br />.!� d�'r� ��'/' y 4/'�^p� �/' � <br />%/, S, De�arf r._;�f of .=�y,-, �.lrv.r. Na �v,-a [ li'csou.Yt s <br />Goiu:•rvKfOh Servrcrs. ��>�q�/at/,�c�> <br />6. /f�;o �; y s�r.:::r-., ««.,, .�f� Gr� f,.�,�,s , <br />. <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undersignetl ownedepplicant he�eby agrees to hold and save harmless <br />ihe City of £verett from any un� all claims for tlamages, costs, expenses, or <br />causes of action that may arise because of installation anC maintenance of <br />lhe improvement or mher right-of-wa, ure h�;reto applied for and further agmes <br />to remove same uoon notice from :he City nnd to rcplace public prope�ty <br />damaged ihereby. <br />� i .l-� vC-" <br />SignaWre of Applicant ate <br />VORK AUTHORIZED BY TFIiS PERP+IIT MU3T BE STARTED WITHIN 180 DAYS OF DATE PERMIT �S ISSUED A!JD THEREAFfER I� TO BE OILI^uENTLY PUHSU[D TO <br />OL4PLETION. THIS PE9MIT \4AY BE CANCELLFD BY THE CITY UPON ANY STOPPAuE OF 11'Oi iK ON ThIS PP.OJECT O�/ER 9U DAVS DUHATION <br />