Laserfiche WebLink
xH <br />t�"'7 <br />r� <br />9H <br />,a�x <br />c H <br />>yti <br />H xs <br />��� <br />oxo <br />'_] H'�J <br />� H <br />h o� <br />H C7 <br />�nb <br />H l�7 O <br />4] � CC�]-' <br />"'L' H 3� <br />r"z <br />HH <br />O � i-' <br />C) Cq7 (/� <br />� C�1 L'" <br />iz-7 O [�/, <br />� <br />Date� <br />�`� <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />�-- <br />, <br />^ � �,; � � �i,�� ��� <br />Address <br />Pul�hc Works Peunu � � �� <br />91a�. �e0��n <br />Pubi¢WOMSFee 5 <br />iolal Fcc <br />Lcss Apul. Fee PaiJ S <br />oaiance oue S <br />7ip Phone <br />�t� � �� — <br />Applicant Mailiny Address City Zip Phone <br />Describe Proposed Work <br />Projecl Address �d known) '� - - <br />Attach four 14) cop�es of plans for pr�posetl work - Draw to scale antl note the foilowinc� ae. applicable. <br />• Propert}• Lines • Centerline of sireet <br />• Outline and dimensions of all exi5tiny and • Indicaie Norih <br />proposed siructures on the lot • Show any proposed 9�.�din9 cii.-mqc; <br />• Exi5tin9 and G«Posed u�ililies • Show measuremenls <br />ISLWE <br />PERIdIT CONDITIONS <br />1. All calls br inspection shall be matle 24 hrs. in advance - Phone 259•881 5 <br />2. All work shall bo performed in aeeortlance wilh Ihis pemw .ind cu�renl Cny ul Evei��,t Desnn anA Consinichon <br />S�andards and Specilicalion5. <br />3. Call Location Underc�round Servicc 48 hrs. bebre You d�q TOLL FREE NUMBER 1•800•424•5555. <br />�� -,�c� �r %�C� � ��� ' : ��%' �-• � , � = i%r ;%I <br />; � f�' < - , <br />S�rr/� � � u�i>i.�� f� � �i=nj /�G�/, � Gu��rG� <br />�;�-r/ %-27��% a r �+. $�o�� 1;.�� G+-<.�' . <br />; . <br />_�—„'✓' -"'"... . ' <br />..�� -�_,��� <br />FINAL INSPECTION <br />Apnroved as Construcletl <br />c��crctt PU�LIC WORKS DEPARTMEN? <br />� "s200 Cedar Sireet <br />[verett, WA 98201 <br />Phnn¢ 25&8815 <br />��__ <br />Date <br />Da�e <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undersigned owner/opplicant hareby agrees to ho�d and s iea h:nm- <br />less Ihe Ctly of Evereti hom any and all claims �oi �fam.�qus. cosk;. <br />ex0enses, or causes ol action Ihat may arise because ol m::tallatiun <br />and mainlenance ol the improvement or other ri9h4ol��vuy usc neicio <br />apPlied �or and luriher a9rees lo �emove same upon nolin- Irom Ihc <br />City and to replace pub°r p�oP�rry damac�ed ihereby. <br />Signature o� Applican� . . Date <br />WORK AUTHORILED BY THIS PEflMIT ;dUST BE STARTED WIThiN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGFhlTLY PURSUED TO COWPLETION. THIS PERMIT MAY B[ <br />CANCELLED BY TH[ CITY UPON ANY STOPPAGE OF WOflK ON THIS <br />P(iOJECT pVGR 90 P�YS DURATION. <br />0 <br />