Laserfiche WebLink
Date��6 Z <br /> �/{!,?� PubLt Workt Pa�mlt� ���9 <br /> Application For �/�� eiay.oeo�.� <br /> PUBLIC WORKS PERMIT PUEI¢Work�Fee <br /> Total Fee = <br /> leu�nol.Fee P�iE f <br /> Print or Type Only e.�.���o�� s 90�— <br /> ,�bt `I� � �o a 3�3 n��,� i� O ' .5.�'-y�5 L <br /> ^ ••-� � maiHngAddress Ci� �o�7J � <br /> V Y Zip Phone <br /> /' <br /> Applicant Mailing AAdreas City c'ip Phone <br /> Describe Proposed Work Or� i�C/'1e � . <br /> � Prolect Address(il known) �� (,�� � <br /> Attach four(4)copies of plans for proposed work• Draw to scale and note the following as applicable: � <br /> • Property Lines • Centerline of street � <br /> � Outline and dimensions o�all existing and • Indicate North <br /> proposetl structures on the lot • Show any proposed grading changea <br /> • Existing end proposed utilities - • Show measurements <br /> DO NOT WRITE BELOW THIS LINE � <br /> PFRMIT CONDIiIONS O <br /> � 1. Ail calls lor inspectlon ahall be made 24 hrs. in advance- phone 2S9•881 5. � <br /> 2. All work shall be peAormed in eccordance witF,this permit and current City of Eve�ett Design and Construction <br /> Standards and Specifications. <br /> 3. Call Lxation Underground Service 48 hrs. before you dig.TOLL FAEE NUMBER 1•$00•424•5555. <br /> � /�or o�,ora,�e d�lurs d2�/ �',/�.-E� � Z <br /> / �� O <br /> � <br /> � <br /> O <br /> a <br /> 07/22/86 IOt39AM OOOAN10B8 <br /> / <br /> ACKNOWLED�OF�I�IONS <br /> W <br /> The undersigned owner/applicant hereby agrees to hold and save harm- <br /> f less ihe City of Everett Irom any and all claims lor damages, costs, <br /> � expenses, or causes of action thal may arise because of installation <br /> !_ r- /� '�,'�2 �'� and maintenance ol the improvement or other right-of•way use hereto <br /> ioved for o�f uction applied for an rlher agrees to remove same upon notice irom Ihe <br /> Date City and to re la e pup1 lic property damageA thereby. <br /> FINAL � Date 7 I�" � � �v V � <br /> ApDroved as Constructed Signature 1 ApplicaN D te <br /> everett PUBLIC WORKS DEPARTMENT WORK AUTHORI2ED BV T S PERMIT MU57 BE STARiED WITHIN <br /> 3200CedarStreet 180 DAYS OF DATE PERMIT IS ISSUE� AND THEREAFTER IS TO <br /> Everett, WA g8201 BE DILIGENTLV PURSUED TO COMPLETION. THIS PERMIT MAV BE <br /> , Phone: 259�8815 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON TNIS <br /> PFOJEC70VER 90 DAYS DURATION. <br />