Laserfiche WebLink
p�pli<\4oiksPermit t 7 L �� <br /> Date�_Z'}�g3 eiae oeo�.. R'3��— <br /> qpplication For <br /> Pu�iic Wa�ks Fae S_ �j�� • � J <br /> plJg�IC WORKS PF:RMIT 1o,°�Fee <br /> �ms noo�Fae Pa�a S O <br /> Balance Due S ��� <br /> Print or Type Only <br /> T 5S' 39 r� �C� 9�t5' l�y3�3�55� <br /> � �ht 1 1 -E' � �0�� k Z�P Phcne <br /> Tv C GI City <br /> � V M2wny nw�....� <br /> Owner �, <br /> � y- �y3�355 <br /> � �TL ��� ° � 1 �/(c3SC afl� - 2, �Y �� I . City .J ' ` �'�'� Phone <br /> - ppplicant Meilinc�Address <br /> � <br /> ' �i — <br /> Describe Proposed Work �-- <br /> W <br /> �� � NR�/ P�.✓ �I�l � <br /> Pro�ect Address(if known) � <br /> Altach four 14)copies ol plans for proposed work•Draw to scale and nole�Ce��,eWine ot stree� a61e: � <br /> � Property Lines • Indicate Norih <br /> • Outline and dimansions of all exisling and � Show ony Proposed grading chonc�es � <br /> proposed slructures on the lot � Show measurements <br /> • Existing and proposed utilities � <br /> DO NOT WRITE BELOW THIS LINE <br /> PERMIT CONDITIONS � <br /> t. All calls lor inspection.hall be made 24 hrs. in ad��ance- Pho� � <br /> 259•8815. <br /> 2. All work shall be parformed in accordance with this peimit nnc c�rreN City ol Everell Design and Corstruction <br /> Standards and Speci!ications. � z <br /> 3. Call Location UnAerground Service 48 hrs. 6e;ore ynu dig.TOLL FREE NUMBER 1•800•424-5555. C` <br /> O � <br /> M <br /> � <br /> � y � <br /> O � F <br /> � � <br /> a � � <br /> � <br /> � �. <br /> � � <br /> � <br /> ACKNOWL EDGEMENT OF CONDITIONS p � <br /> -i.e i�ndersigned owneqapp���ant hereby agrees to hold and save harm- Cy . <br /> H � <br /> ---�� lc.;s che City of Everetl Irom any and all claims for damages, custs, y t <br /> ,.tUenses, cr causes of action that may arise because ol installation 2 <br /> � ��`_— nnd maintenance ot Ihe improvemenl or olher right-oi-waY ue� he�`�° O � <br /> !!- 5�'�3 applied lor and further agrees to remove same upon notice Irom the � r, <br /> '� Datqqq City lo reP�ace public proPerty damac�ed thereby. � F, <br /> prove u C t iction I`-���, �� <br /> ' � ,r ,o—i7—`b� v, <br /> ��,/ ,� !Y Date r. <br /> Dale licanl � �� <br /> FINAL INSP-CT�ON ignature of App� <br /> qpproved as Constructed WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED W�THIN � :� <br /> PUBLIC WORKS DEPARTMENT 1B0 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO ' <br /> everctt BE DILIGENTLY PURSUED T� CCMPLETION.THIS PFR�Af� MAY BE <br /> � 3200 Cedar Street `� <br /> Everelt,WA 98201 CANCELLED BY THE CITY UPON ANY STOVPAGE OF WORK ON Tlil <br /> Phonc�. 259-8815 PROJECT OVER 90 DAYS DURATION. <br /> � <br />