Laserfiche WebLink
- -, <br /> �8te_��k��� Pu�lic Wa�ke Permit r __j4�����_ <br /> / / <br /> Applicatioo For eiac.nao��• <br /> PUBLIC WORKS PERMIT PuoToalFeeFee s �o �= <br /> �esa ApPI Feo PeIE .S <br /> Balance Dua S ��LU � <br /> Print or Type Only = <br /> Sooc/s�� �9 z3 owkes J�'�r_��tt- 98'�a3 2Sz- ,�ty�33 <br /> Owner Mailing Address City Zip phone <br /> Sr��(Sf.-�. S a-.ti-, � <br /> Applicant Maliing Address City Zip Phone o <br /> /� /1 --I <br /> DescribenProposedWork tPa.leue �i '70:�iex! pT �lc��p tw��c�k �o D�ciC� �7Pav,� m <br /> 1J�IcYE_Y' �lJ� �� l�AL6 .. <br /> 1 T <br /> W N= <br /> m <br /> Pro�ectAddress�ilknown) Oa�CC. w� � <br /> co <br /> m o <br /> Attach four(4) copies of p�ens lor pwposed work- Draw to scale and note ihe lolbwing as applicable: � —�c <br /> • Property Lines • Centerline ol street � �m <br /> � Outline and dimansions of all existing and • Indicate North —� z <br /> proposed structures on the lot • Show an = � <br /> y proposed grading changes m <br /> • Existing and proposed utilities • Show measurements � ,p Z <br /> DO NOT WRITE BELOW THIS LINE � _ <br /> PERMIT CONDITIONS O < N <br /> 1. All calls for inspection shall be niade 24 hra in advance- phone 259•$81 5. � o p <br /> � � <br /> 2. All work shall be performed in accordance with this permit and current City of Everett Design and Construction �m <br /> Standards and Specifications. _ <br /> 3. Call Location Underground Service 48 hrs. before you dig.TOLL FREE NUMBER 1-800•424•5555. � m � <br /> .� R�� w s��P��� �-� ��� � C�-s ..Z�i�����' �m <br /> O 4� <br /> N <br /> Z C7 <br /> --I r <br /> � • m <br /> a <br /> � <br /> � � <br /> x <br /> a <br /> z <br /> � � <br /> � <br /> a N <br /> _ <br /> 0 <br /> � <br /> � <br /> m <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees to hold and save harm� <br /> � less the Cily ot [veretl from any and all daims for damaqes, cosls, <br /> expenses, or causes ol action tha� may arise because ol insl�llation <br /> anA maintenance ol the improvement or olher nght-of-way use hereto <br /> ' appliea for and lurther agrecs to remove same upon notice Irom Ihe <br /> App d r on ~ ' Date Cit an replace pub{jc propert maged Ihereby. <br /> / � <br /> ..' ����� �� '1���- �/�,_Fj � / - <br /> FIM�LINSPECTION ' Dae ' � ' <br /> Approved es Cons�ructed ignature of Applicant Date <br /> everett PUBLIC WORKS DFPARTMENT \NORK AUTHORIZED BY IS PERMIT MUST BE STARTED WITHIN <br /> � 3200CedarStreat 180 DAYS OF DqTt PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everet�,WA 98201 BE DILIGF�J iLY PURSUED TO COMPLC-TION. ThiIS P[RMIT MAY BE <br /> Phone: 259-8875 CANCELLED BY THE CIT1'UPON ANY STOPPAGE OF WORK ON TIiIS <br /> I PROJECT OVER 50 DAYS DURATION. <br /> 1 <br />