Laserfiche WebLink
Date � �X� • • PUCIit Works Permit• <br /> ApplicationFor Bieo-Deo�.• ��� s <br /> PUBLIC WORKS PERMIT PuOTotalFeeFee s - <br /> �ass nooi.Fea ve�o S <br /> aalance oue S <br /> Print or Type Only <br /> � <br /> S �1,� ����i�� :r',��r, i�,�n�U :�!�;c�' I= �n��tt Gv,�- .5�/)-a3/0 <br /> wner Mailing Address City Zip Phone <br /> ��cCC�i- s �c,rllY.icl c vt l�d�o -l5( /�' �.������r.�„vi /t,r) �)� a�? 4 /� s � - � ,�� <br /> AppliEant Mailing Adtlress City ✓ Zip Phone <br /> J / 1 <br /> Describe Proposed Work %� � �5����«� �1 �— �/11 //C l% �l i]E� i�LII`�b � �i/ih'i � <br /> / ' <br /> /1 , W <br /> Project Address(it known) ��i r� ���'/'�Q(��f!L�'���� � <br /> Attach four(4)copies of plans lor proposed work- Draw to scale and nole the lollowing as applicable; � <br /> • Property Lines • Centerline of street � <br /> � Outiine and dimensions of all existing and • Indicate North <br /> proposed structures on the lot • Show any proposed grading changes <br /> • Existing and proposed utilities � • Show measurements � <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 1. All calls for inspection shall be made 24 hrs. in advance-phone 259•881 5. � <br /> 2. All work shall be performed in accordance with this permil and current City of Everett Design and Construction <br /> Standards and Specifications. <br /> 3. Call Location Underground Service 48 hrs. before you dig.TOLL FREE NUMBER 1-800•424-5555. � <br /> �1� 7 �� � _ <br /> !/•'_"°f`Li�:,. (v�^'>�-?+,/✓'.✓_.'7_�.t" � � .i:ti l'-�r: .-�;,. <br /> i' <br /> % <br /> - ,��,1 y�/�, ` I- <br /> N <br /> O <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees to hold and save harm• <br /> less the City ol Everett irom any and all c�aims tor damages, costs, <br /> expenses. or causes of action that may arise because of instailation <br /> and maintenance ot the improvement or other righl-of-way use hereto <br /> applied lor and further agrees to remove same upon notice Irom the <br /> Approved for Construction Date City and to replace public property damaged thereby. <br /> FINAL INSPECTION Date <br /> Approved as Consiructed Signature of Applicant Date <br /> everett PUBLIC WORKS DEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> � 3200 Cedar Street 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> BE DILIGENTLY PURSUED TO COMPLETION.THIS PERMIT MAY BE <br /> Everett,WA 98201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone: 259•8815 PROJECT CVER 90 DAYS DURATION. <br />