Laserfiche WebLink
� � � <br />Q � <br />��� <br />��� <br />W <br />�O <br />�MC <br />� W <br />Qr <br />t� H <br />W <br />M <br />�� <br />6� <br />� <br />u� <br />� <br />� <br />r <br />Date �-1-91 <br />.h <br />Application For <br />PUBLIC V,(ORKS PERMIT <br />Print or Type Only <br />Pum¢ worAs Permn . <br />eiay o�o� • 91/27233 <br />PUCI¢Workeiee s <br />Total Fe� ! <br />Lf]S�DP<<lEFa�E `!� <br />BBIp11Ctl �Y! i <br />Niegeman, S[an 1006 harborview Lane Everett WA 98203 259-4969 <br />pw�e� Mailing AdAress City Zip Phone <br />Applicant Mailing Address City Zip Phone <br />Describe Proposed Work �� �' a * G' a rl rl �n OLLt51ae St81Ts <br />Project Atldress (il known� <br />Attach four 14) copies of pians for proposed wo�k • Draw lo scale antl nole ihe following as applicable: <br />• Property Lines • Centedine ol street <br />• Outline and dimensions ol atl existing and • Indicale North <br />propOsed struCtures on the lOt • Show any pwposed grading changes <br />• Existing and proposeC u�ililies • Show measurements <br />PERMIT CONDITIONS <br />7. All catls tor Inspection shell be made 24 hrs. in advance • phone 259�8870. <br />2. All work shall be pertormed I� ectordence with this permit and current Cily of Everatt Design end Construclion <br />Slanderds end Specifitations. <br />3. Call Location Underground Service 4B hrs. betore you dig. TOLL FREE NUMBER 1$00�424•5555. <br />��/�Nce ldnz%. /��,�,u. / ���7`.CI ��«-vo� <br />Approved lor Construction Date <br />FINAL INSPECTION Date <br />Approvetl as Constructed <br />�PUBLICWORKSDEPARTMENT <br />3200 Ceder Street <br />Everett, W.4 98201 <br />Phone: 259-8010 <br />' la/L l�.-'. cr�f � <br />7 Z-Y/� <br />ACKNOWLEDGEMF.NT OF CONDITIONS <br />� <br />O <br />� <br />� <br />O <br />a <br />The undersigned owner/applicant hereby agrees to hold and seve harm� <br />less the City ol Everetl Irom eny anA all claims lor damages, costs, <br />expenses, or causes ol action that may arise because of Instellation <br />and mamtenance oi the improvement or other right�ol-way use hereto <br />applied for and further agrees to remove same upon notice Irom the <br />City and to replace public properry damaged thereby. <br />Signature ol Applicant Date <br />WORK AUTHOR12ED BY THIS PERMIT MUST BE STARTED WITHIN <br />1B0 DAYS OF DATF PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLV PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJF.CT OVER 90 DAYS DURATION. <br />:�: <br />� <br />, <br />