Laserfiche WebLink
Date��' ';:'j-� 9 9 <br /> _— � r„����„�,�.F�,� _ �,� <br /> Application For oieo.oon��• ��`-� v c <br /> PUBUC WORKS PERMIT P°°���Wa�ksFee � <br /> Toial Feo S_ <br /> Less AppL Fea Paid $�� -- <br /> Balnnce Uua $ ��� <br /> Print or Type Only <br /> ��-ci,� � -�� aal �z����� ����� s� s�. .���� Q,e�� �3��-�l��-I <br /> wn r Mailing Address City Zip phone <br /> ����-�C.. ^ s� �� �� <br /> Applicant Mailing Address City Zip Phone <br /> Describe Proposed Work (���J���'c� <br /> Project Address(if known) l�fP02 �B '— �I u w. � �ie, _ � <br /> � <br /> Attach four(4)copies of plans lor proposed work- Draw to sca�e and note the lollowing as applicable• � <br /> • Property Lines • Centerline ot street � <br /> • Outline and dimensions of all existing and • Indicate North <br /> proposed st�uctures on the lot • Show any proposed grading clianges <br /> • Existing and proposed utilities • Show measuremenis � <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 1. All celis for i�spection shall be niade 24 hrs. in advance- phone 259•$81 5. � <br /> 2. All work shall be performed in accordance with this permit and current City of Everetl Design and Construction <br /> Stardards and Specifications. <br /> 3. Call Loca�ion Untler�7round Service 48 hrs. before you diq. TOLL FREE NUM6ER 1-800•424-5555. � <br /> O <br /> � <br /> � <br /> O <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> � The undersi{3ned owner/applicant hereby agrees to hold and save harm� <br /> less the Ciry of Everett Irom any and all claims for damages, cos�s, <br /> �� �a�� �/o/g expenses, or causes ol action thal may arise because ol installation <br /> and maintenance ol Ihe improvement or other right-ohway use hereto <br /> � applied lor and lurther aqrees to remove same upon notice Irom the <br /> Approved lor Const U'6n Date Cit and to re lace ublic ro ert dam <br /> / Y P P P P Y 9edthereby. <br /> �/ �iy,�s'— �T <br /> FINA INSP CTION Date '�L �L� <br /> Approved as Cons�ruc�ed Si ure ol A licanl Date <br /> evere[t PUBLIC WORKS DEPARTMENT WORK AUT ORIZED EY TIiIS PERMIT MUST BE STARTED WITHIN <br /> � 3200 Cedar Sireel 180 DAYS OI- DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everett. WA 98201 BE DILIGENTI.Y PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Phone: 259-9815 CANCELLED BY THE CITY UPON ANV STOPPAGE OF WORK ON THIS <br /> PROJ[CT OVER 90 DAVS DURATION. <br />