Laserfiche WebLink
Date.��� � � <br /> Pu�Lr Works Permit• <br /> Application For eieo.oee�.._�T���/�_ <br /> PUBLIC WORKS PERMIT Pueiolal{reeFee a <br /> � Lesa Run�.Fee f�eia S <br /> Print or Type Only Ba�a�=ao�� S <br /> —L�7u���. �C ��'i X �� � �MIf� �/Y�N //��/��� �.S 7Y n7"n �f"YY' <br /> Owner MaJing Address City zip ' - Phone <br /> Applicant Mailing Address City Zip Phone <br /> Describe Proposed Work _ 7Pu�r�� � dr��`p�/p�ry/,u ',7C- — n n, `' `� / nn6,yQqn� ��� <br /> —_7 �"_`y,�.cf�—�,�. / _ <br /> Pro�eCt Address(il known) � I [�) �a C��L`(� �v� �`��I l _ �,,,/ � <br /> r� �_ � <br /> , Attach four(4)copies of plans for proposed work- Draw to scale and note the following as aoplicable: � <br /> � Property Lines • Centerline ol street � <br /> � • Outline and dimensiens ol all ezisling and • Indicate North <br /> . proposetl structures on ihe Iot • Show any proposed gtading changes <br /> . • Existing and proposed utilities • Show measurements � <br /> DO NOT WRITE BELOW THIS LINE <br /> � PERMIT CONDITIONS � <br /> ; 1.All calls for inspeciion shall be made 24 hrs.in advance•phone 259•8810. � <br /> , 2.All work shall be peAormed in acwrdarce with this permit and current City ol Everetl Design and Construction <br /> Standards and Specifications. <br /> , 3.Call Location Underground Service 4B hrs.before you dig.TOLL FREE NUMBER 1-$00-424•5555. � <br /> s <br /> ; ��j ��� ..� ...�/�gt4 O <br /> i / <br /> � <br /> � <br /> O <br /> a <br /> ACKNOWLEDGEMENT OF CONDITICNS <br /> The undersigned owner/applicant hereby agrees to hold and save h�rm� <br /> less the City of Everet� Irom any and all claims for damages. costs, <br /> expenses, or causes ol action that may arise because ot installation <br /> and maintenance ot the improvemen� ;r other rlght-of-vaay use I;�rreto <br /> applied for ard further a rr.es to remove same u on notir,e �rom ihe <br /> Approved lor Construction Dale City and to replace public property ramaged thereby. <br /> FINAL INSPECt10N Date <br /> Approved as Consiructed S:gnature of Applicant Date <br /> everett PUBIIC WORKSDEPARTMENT WORK AUTHORIZED �Y THIS PCRMIT MUST BE STARTED WITHiN <br /> � 3200CedarStreet 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everetl,WA 98201 BE DILIGENTI.Y PURSUED TO COMPLETION. THIu PERMIT MAY BE <br /> Phone:259-8610 CANCELLED BV THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> � PROJECT OVER 90 DAYS DURATION. <br />