Laserfiche WebLink
Date� Pu�licWorksPer � 86— /75" <br /> Application For eiep.Deo�.� _ <br /> %6a �'.S <br /> PUBLIC WORKS PERMIT PUDto�alFaeFee s <br /> Less AppL Fee Paid S <br /> Balan<e Oue S ��� <br /> Print or Type Only <br /> �l C h ct 1- 6 �Lt I I �UG� � ,/( (J�rG l, I IT� ��'� C.ll<Y c=I I /C)�,G� � ✓��7 �(-.7�r-±S�C <br /> Owner Mailing Address City Zip Phone <br /> S r�� ,�bo,�� <br /> App�icant Mailing Address City Zip Phone <br /> /, � � L 1 <br /> Describe Proposed Work /V c=�✓ - [� •� � 1 � O� ���`� � <br /> Q �+ W <br /> Proiect Address(if known) � C;__. �` rq�� cl Q V� . � <br /> Attach tour(4)copies oi plans for proposed work• Draw to scale and note Ihe followinA as applicable: � <br /> � Property Lines • Centerlime ot street � <br /> • Outline and dimensions of all exisling and � Indicate IJorth <br /> proposed sVuctures on the lot • Show am,�proposed grading changes <br /> , � Ezisting and proposed utilities • Show measurements M <br /> W <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 1. All cal�s for inspection shall be made 24 hra in advance-phone 259•881 5. � <br /> 2. All wo�:.a.`.:.!�be performed in accordance with this permit and wrrent City of Everett Design and Gonstruction <br /> Stands•�1s antl:oecifications. <br /> 3. Call Lcc..'+an Un�lerground Service 48 hrs. belore you dig.TOLL FREE NUMBER 1-800•424•5555. � <br /> y Tp �' Cpr�-'�"%,elic7�E.0 �Ei� �9s�.�izadEv O <br /> fL�9R/S vHTE�:O 3�-/-86 <br /> � <br /> � <br /> O <br /> a <br /> ACKNOWIEDGEMENT OF CONDITIONS <br /> The undersigned ov�ner/applicant hereby agrees to hold and save harm- <br /> less the City of Everett Irom any and all claims for damages, costs, <br /> � — �� expenses, or causes of action that may arise because of installation <br /> and maintenance of the improvement or olher right•of•way use hereto <br /> e� �' applied for and furiher agrees to remove same upon nolice from the <br /> Ap ved for ons ction Date Ciry and to r la public perty dam ged thereby. <br /> � �� _ -o?G -� ! <br /> FINAL INSPECTION Da?A � <br /> Approved as Constructed Sig urebf Applicant , - <br /> everett PUBLIC WORKS DEPARTMENT WORK AUTHORIZED B HIS PERMIT M E START WITHIN <br /> � 3200 Cedar S�reet 180 DAYS OF DATE P�AMIT IS ISS AND THEREAFTER IS TO <br /> Everett,WA 98201 BE DILIGENTLY PURSUED TO COMPLETION.7HIS PERMIT MAY BE <br /> Phune: 259•8815 CANCELLED B1'THE CITY UPON ANY S70PPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAYS DURATION. <br />