Laserfiche WebLink
/,Date��� � PuELCWorkSPermil• -�`� � _�� <br /> � Application For eiae�oec�..�Z/ / 7.Fp�_ <br /> pUBLIC WORKS RERMIT PVoTa�alFeeFee S <br /> �ess Aoni.Fee Paia S <br /> Print or Type Only 9alanceDue S ZU� <br /> P�,u,_ � I��oyc� �Sl� rz. Ci12Al�� �vc2�7' `�P� I <br /> Owner Mailing Address City Zip Phona <br /> ,d,T L�s„Z. �, v. r�xwza- ���-�,- ���:v� 33�-�z.3� a <br /> Applicant Mailing Address City Zip Phone <br /> Describe Proposed Work K�c.�YZ� n 1'� — �'7C tr 1�7�t7� W��;�¢3�1�� $' 1`'�C.�l1 i <br /> c� <br /> W <br /> Prolect Address(if known) S�$ A`� c�:�71-�1L�IL._ AcLSc:��/�� � <br /> Attach four(4)copies ot plans for proposed work• �raH•to scale and note the following as appliceble: � <br /> • Property Lines � Centerline of street � <br /> • Outline and dimensions ol all existinQ and • Indicate North <br /> proposed structures on the lot • Show any proposed graAirg changes <br /> • Existing and propos�d utilities • Show measurements � <br /> DO NOT WRITE BcLOW THIS LINE O <br /> PEPMIT CONDITIUNS <br /> 1. All calls for inspection shall be made 24 hrs. in advance• phone 259•8815. � <br /> 2. All wqrk shall be performed in accordance with this permit and current City of Evere;t Design and Construction <br /> Standards and Specifications <br /> 3. Call Location Underground Service 4E hrs. before you dig.TOLL FREE NUMBER 1•800•424•5555. � <br /> O <br /> � <br /> � <br /> O <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> �'9� The undersigned owner/applicant hereby agrees to hold and save harm- <br /> less the Ciry ol Everett Irom any and all claims for damages, costs, <br /> _ // expenses, or causes ol action that may arise because of installation <br /> �'f�� f_ ��J/�7 and mainjenance of ihe improvement or other right-of•way use hereto <br /> i �.c u G�'_ <br /> �' applied'(or and-further a e >o remove same upon notice from the <br /> Approved for Construction/��,- Date City�and to r � ub�� � operry da �jed thereby. <br /> �-l� �-��" '� }� <br /> �-r,�-��� �..��:�� ,, , <br /> , <br /> FINAL INSPECTION Date ��'�_�� �"�` � � `--' <br /> ApproveG as Constructed Signature of Ap licard i / , D le <br /> everett PUBLIC WORKS DEPARTMENT WORK AUTHORIZED BY THIS P�RMIT MUST BE STARTtD WITHIN <br /> � 3200 Cedar Street 180 DAYS OF DATE PERAIIT IS ISSUED AND THEREAFTER IS TO <br /> Everett,WA 98201 BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Phone: 259•8815 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> `J PROJECT OVER 90 DAYS DURATIrJN. <br />