Laserfiche WebLink
i <br /> � <br /> �1 VupM1c Wm�s Pemd• <br /> Date_� .- �FS. ..cZoZ2��- <br /> uian neoi • <br /> Applica��..n For <br /> PUBLIC WORKS PERMIT °°°;o.°Fe�`Ce s-- — <br /> lessApD�-ieePn�O � <br /> eaianre Duc S <br /> Print or Type Only <br /> t�_ � .. � i ,. ..� Ca p.r- P� �z��'� �ve�r;�{- ��'z� ti zSz —. i� � <br /> Owner Mailin�Fddress Cdy Lp Phone <br /> /�. � ' � �.T ! __ <br /> Ap, hcan Maihng Address Cdy Lp Phone <br /> Describe PropoSed Work _ �P�-LQUpu�'�'�� ' ��/��� — <br /> /I W <br /> Prolect Address(if known) '�_y�'���1AY' IT—Q-- � <br /> Attach four�41 copies ol p�ans tor proposeA work- Draw to swle and note ihe fo�lowing as applicable: w <br /> • Property Lines • Centerline c�t street � <br /> • Ou;lir,e and dimensicns of all existing and • Indicale Noilh <br /> proposed structures on ihe lot • Show any preposed grading chanqes <br /> • Existing anA proposed utildies • Show measurements M <br /> W <br /> DO NOT WRITE 6ELOW THIS IINE O <br /> PERMITCONDITIONS <br /> i.All calls lor inspection sha�l be made 24 hrs.in advance•phone 259•8810. � <br /> 2.All work shall be pedormed in accordance with this permit and wrrent City of Everett Oesign and Construction <br /> Standards ar�d Specilications. <br /> 3.Call Location Undergrourd Service 48 hrs.betore you dig.TOLL FREE NUMBER 1•800•424-5555. � <br /> O <br /> r-- � <br /> IL}C;� �.�.� ��-_l�►�1 �i ��-�'� � <br /> � _�. �i- O <br /> �-�,���� �E�. <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees to hold and save harm� <br /> — —� less the City ot Everell Irom any and sll claims lor damages. costs. <br /> expenses. or causes of aclion that may arise because ol installatioii <br /> and mairtenance ol Ihe improvemeni or other ri9ht�ol-way use hereto <br /> applied lor and further agrees to remove same upon notice Irom ihe <br /> Approved lor Constructinn Date Ciry and to replace pubfic property damaged thereby. <br /> FINAL INSPECTION �a�e Date <br /> Approved as Censtructed Signatwe ol Applicant <br /> WORK AUTHORI2ED BY THIS PFRMIT MUST BE STARTED WITHIIJ <br /> everelt PUBLICWORKSDEPARTM[NT 1g0 DAYS OF DATE PERMIT IS ISSUED AND THEREAfTER IS TO <br /> � 3200CedarStreet BE DILIGCNTLY PURSUED TO COMPLEiION. THIS PERMIT MAY BE <br /> Everett,WA98201 CANGELLED DV THE CITV UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone�.259�8810 PROJECT OVER 90 DAYS DURATION. <br />