Laserfiche WebLink
/ <br /> �� �� <br /> Date_y� P„����w�,.s�,,,�„�, c5�..�..� <br /> Application For e�no o�o� • —_1�g��,��y <br /> PUBUC WORKS PERMIT P°°°°W°,k.F°a <br /> TotN Fne S_ <br /> LessAp01 Fee Pni� S <br /> Balnnce0uc S ��� <br /> Print or Type Only — <br /> �.. � , c. ., ti., ;. � (,� ��B �� � ��t �x�.►�' 9��1 �_ <br /> —��,�e� MaiNng Atldress City Zip Phone �'7 <br /> / <br /> Ul�l,l.,�/� ��• I��—� �Dl�' ►-2 � �'t�e � 4�LDI� <br /> Applicant MaJing Address City Lp `f�o� _ ��� <br /> _r <br /> Describe Proposed Work ; `�w��� � <br /> W <br /> Proiect Address lif known) G�G�2 � f��yL -S�: � <br /> Attach lour(4)copies ol p�ans for proposed wo�k- Draw to scale and note the following as applicable � <br /> • Property Lines • Centerline of street � <br /> • Outline and dimensions of all existing and • Indicate Norih <br /> proposetl 5tructures on ihe lot • Show any proposed grading changes <br /> • Existing and proposed utilities • Show measurements � � <br /> DO NOT WRITE BELOW THIS LINE . O I <br /> PERMIT CONDITIONS � <br /> 1.All calls for Inspection shall be mede 24 hrs.in advance-phone 259•881 O. � I <br /> 2,All work shell be peAormed in accordance with this permit and current City of Everett Design and Construction <br /> Standards and Specifications. ! <br /> 3.Call localion Underground�evice 4B hrs.before you dig.TOLL FREE NUMBER 1•800�424-5555. � ( <br /> � <br /> O <br /> � <br /> � <br /> O <br /> a�- <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees to hold and save harm- <br /> less the Gty ol Everetl irom any and all claims br damages, costs, <br /> — // expenses, or causes o� action i6a' -�ay arise because ol installation <br /> � �!,� � I�� �7 /q �0 and maintenance of the improvement or other righl-oi-way use hereto <br /> �1C ':. !y' i i i_ applied tor and turther agrees to remove same upon notice Irom the <br /> Approved for Cons r j n Date City and lo replace public property damaged lhereby. <br /> --1� �' �/�/— 'J"r^O /��I((LK:.� ��%�l/(t.�i <br /> FINAL INSFECTION Date '�� � ,:r u'� <br /> Apprnved as Constructed Signature Auplicant r, Dale <br /> WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED VJITHIN <br /> everett PUBLICWORKSDEPARTMENT 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200 Cedar Street BE DILIGENTLY PURSUED TO COMPLETION.THIS PERMIT MAY BE <br /> Everett,WA 99201 CANCELLED BY THE CITY UPON ANV STOPPAGE OF WORK ON THIS <br /> Phone:259�Bd10 PROJECT OVER 90 DAYS DURATION. <br />