Laserfiche WebLink
�� <br />� <br />TYPE OR PRINT ONLY <br />y � <br />Application For <br />PUBLIC WORKS PERMIT <br />°w"8` P/2vp�-�Ty <br />sl��ie <br />Applicant <br />Describe Pioposed Work <br />PUBL�C WORKS DEPARTMENT <br />3200 Cedar Strezt <br />Everett, WA 98201 259-BBt 0 <br />O�1 <br />r r <br />PROJECT ADDRESS (if knawn) Z lc D <br />Date g� LZ - 9 � — <br />Public Works Permit R Z/ 8 <br />Building Permit N <br />PublicWoiksFee$ 20� <br />8K <br />� City Zip . Phone �.1 c fA <br />�� no�,��.���,,�s ��SS JCi4TiDN !&�'•� �6 �- r <br />Attach tour (4) copies oi plans for proposed work - Draw to scale and nNe the following if applicable: <br />�Property Lines 'Outline and dimensions of all ezisting and proposed structures on the iot •Ezisting and proposed utilities <br />'Centerline of street •Indicate North •Show any proposed grading changes •Show measurements <br />PERMIT CONDITIONS: <br />1. All calls for inspection shall be made 24 hours in advance - phone 259-8810. <br />2. All work shall be performed in accordance with this permit and curtent City of Everett Design and <br />Construction Standards and Specifications. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800-424-5555. <br />p9-15-97 2:�8'li <br /># 97�58 <br />� C�IL rro"r <br />�O/JCr'�CG . <br />/hS�OG� G/�iOh <br />6eTo r'e �ou �r:�� 20.00 <br />.S WCN�' L�v Be �vne �oei^ S��n�4r� <br />t.ASli <br />c Ha� � <br />.3aG �dPf� �kbc�ico� <br />W <br />� <br />� <br />V♦ <br />� <br />O <br />� <br />� <br />O <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undersigned owner/applicant hereby agrees to hold and savz harmless <br />the City of Everett irom any and all claims for damages, cosls, ezpenses, or <br />causes of action ihat may arise because of installation and maintenance of <br />ihe improvement or other right-of-way use hereto applied for and further agrees <br />to remove same upon notice from the City and to replace public property <br />damaged thereby. <br />�gnatu,r�e o Applicant �� Date <br />COMPLETION. T'HIS ERMIT MAY BE CANCELLEG 8Y THE CIIYIUPON ANY S�TOPPAGE OF WORK ON THIS PROJEC 0 ER 90 DA SEDUILRATIONLY PURSUED TO <br />