Laserfiche WebLink
��Hx <br />C�M <br />H�� <br />�oH� <br />'9 � � <br />Hy <br />z^S <br />O H d <br />��,g <br />4� � c� <br />t"y� <br />i-+ y <br />gy <br />H <br />f1 Ct7 N <br />t�1 <br />H� <br />HO�n <br />oate_� �� 3 /� � <br />Applica�ion For <br />PUBLIC WORKS PERMIT <br />Prinl or Type Only <br />l�.rf' %�ir d <br />Describe PraPosed Work <br />�J! <br />Gr��� � /��'lru� <br />Add�ess <br />ntldress <br />� r C! aln C� <br />PuolwWoiMePcim�t• `� ��� / <br />Biaa oea� • <br />Puoi,c Woiks Fae S <br />Totnl Fea <br />Lesa PpOI Poe Pa�� 5 �D� <br />Oa�ence �ue S ' <br />�02 - 3ZZyo / 7s.; / <br />kvr�l7l rg�ol ?-SQ- 25�; <br />f11VIIC <br />X�� ri'rcir �rly Goc�� �i�,il.��.c/ . <br />— -}– � <br />Proiect Address �il known) " - — � <br />qtlach lou� (4! r.opies ol plans lor pmPosed worM � Oraw to scale and nole � CQ°�;erline oi tpeel able: <br />• properry Lines • Indicate North <br />• Outline and dimensions of all e:islin9 and � Show any proposed g�ading cha��9es <br />proposed slrucWres on ihe lot • Show measurements <br />• Eaisling and proposed utilities <br />PERMIT CONDIT�ONS <br />1, All calls lor inspection shall be made 24 hrs. in advance - phone 259•8810. <br />2. All work shall be pedormed in accordance wilh ihis permit antl currenl City ot Everelt Design and Consiruction <br />Standartls and Specifications. <br />3. Call Locatio� Underground Service 48 hrs. belore you dig. TOLL FREE NUMBER 1-800-424•555 . <br />����- / %j��z <br />qpproved � C nsirygtion > Date <br />i <br />��� � ,;: �-i} -9Z <br />FINAL INSPEC710N Date <br />pppmved as Consimcted <br />�� � PUBIIC WORKS DEPARTMENT <br />,/�'�� 3200 Cedar Streel <br />� Everelt, WA 98201 <br />Phone:259�8810 <br />Ai.KNO�NLEDGEMENT OP CONDITIONS <br />W <br />H <br />� <br />N <br />� <br />O <br />� <br />N <br />� <br />a <br />The undersignetl ov.�ner/aPp��ce^� hereby agrees to hold and save harm� <br />less Ihe Gty ot Everett Irom any and all claim< for dama9es, wsts. <br />�xpenses, o� causes of action that may anse ne:ause ot Installa�ion <br />and maintenance ol Ihe improvemenl or other rignt�ol•way use hereto <br />applietl br and lurther agrees to remove same upon notice from ihe <br />Cily and to replace pubhc pmPerty dama9ed ihereby. <br />�,�,�c/ C �t r�� �/�� �9z <br />Da�e <br />SignaWre ot APPlicant <br />80RD VSTOF DATE PERMIT SEISSUED ANDBTHEREAFTER ISHTO <br />BE DILIGENTLI' PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />