Laserfiche WebLink
Public Worka Pormit� 1Ll��—�/ <br /> Date e�a, oe,� . � <br /> Applicalion For <br /> PUBLIC WORKS PERMIT PUEbcWorkaFee <br /> Total Fee s <br /> Lees Aoo�Fee PaiE 5 --� <br /> � Baience Due 5. <br /> Print or Type Only <br /> , dr �/.2lle r /S/.�fQCiF/G� Fi�is�.� <br /> 6 ner <br /> Mailinp Address �i�Y ZiP Ph°�e <br /> /✓�,Y-�'��r���.es iy�os�-�9�d�'E<t�E�c�i,�NaS Z9�nzn P7�3-�8��/ <br /> Applicant Maihng Address City <br /> Describe Proposed Work _ <br /> _� fiJ .� .dil — // �ilC.f-S' /.iJ �S%�/�,/.DG�' <br /> ,� Fe�•��- oF' ,a,00,�css W <br /> r roject Address(if known) � <br /> � <br /> � AttaCh four(4)Cupies ol plans tor proposed work-Draw to scale and note the Iellowing as applicable: � <br /> 1 • Property Lines • Centerline ol ;ireel <br /> • Outline and dimensions oF all eaisting and • Indicale Ncrih <br /> proposed strocturv� o^the lot • Show any nroposed grading changes <br /> • Existing and p�cPosed uti1G:^s • Show measurements � <br /> �n n!pT WRITC- BELOW THIS LINE O <br /> PEHMIT CONDITIOtJS � <br /> 1. All calls for inspection shall be made 24 hrs. in advance- phcine 259-8815. <br /> 2. All work sha11 be periormed in accordance with this permil and current City ol Everett Design and Construdion � <br /> Standards rnd Specitications. � <br /> 3. Call Locafion Underground Service 48 hrs. betore you dig.TO.LL FREE NUMBER 1•800•424•5555. � <br /> O � <br /> /�if 2 Tid G S�v��vd c.G� 7'o d'E k'6r'> <br /> c��Q,�� a�,���,�ti «�.�t-. <br /> i � y ~ <br /> d � �. <br /> I � <br /> ' a' � � <br /> I � « <br /> , ppp . <br /> ACKNOVJLFDGEMENT OF CONDITlOkS r :. <br /> � l he undersigned owner�applicant hereb�agrees to helJ and save harm- y � <br /> — — less th= City of Everetl from any and all claims for damages. costs. K <br /> /� �J� � CC � eapenses, or causes of action that may arise because ol ,rstallation Q ., <br /> and maintenance ol the iR.provement o� other righ�-ohwey use hereio ; <br /> / applied for and turiher agrees to remove same upon notice trom the a ' <br /> Apor ved lor Con�truction `. � �a1e City anA to rep�ace puplie-ryra�erty dama0ed thereb'. / ~�`*j � � <br /> i <br /> �i/.��� /' �'-d:-' ���� ��-� � ` <br /> �[Y z'Y , <br /> •�114At1N5PECTION �a1e - Date <br /> Approved as Constructed Signa�ure of APP'icanl � <br /> WORK AUTHORIZED BY THIS PERMIT MUST B ST RTED WITHIN <br /> �everett11 PUBLIC VJORKS DEPARIMENT 100 DAYS OF DP.TE PERMIT IS ISSUED AND THEREAFTER IS TO • � <br /> 3200 Cedar Slreet BE DII.IGENTLY PURSUED TO COMPLETION. THIS PERIdIT MAY BE <br /> Everztt.WA 9E20.1 CANCCLLED BV THE CITY UPON ANV STOPPAGE OF WORY ON THIS <br /> Phone: 259-Bti15 PROJECT OV[R 9U Dl�YS DURATION <br />