Laserfiche WebLink
, <br />Date - � <br />Application For <br />PUBLIC WORKS PERMIT <br />Public Works Petmll e �" _ / � <br />eiae� ooa�.• <br />Pu�liC Wo�ks Fee <br />Total Fae s <br />I Less AppL Fea Peitl S <br />� aaio��ao�a S .�U_�� <br />Print or Type Only <br />���� �1rlc�^ ��a�h�y��v���nu�p �� .��Hom�N 9�Q�qn _-s[�- <br />Owner Mailing Address City Zip Phone <br />�rim� <br />Applicant � Meiling Address City Zip phone <br />Describe Proposed Work ����.�( �'�_�� <br />Pro�ect Address (if known) <br />Attach four (4) copiec of plans for proposed work • Draw to scale and note Ihe foliowing as applicable: <br />• Property Lines .• G•nterline of street <br />• Out�ine and dimensions of all existing and • i,idicate North <br />proposed structures on the lot • Show any proposed greding changes <br />• Exlsting end proposed uillities • Show measurements <br />PERMIT CONDITIONS <br />1. All cells for inspection shall be made 24 hrs. in advance • phone 259-881 5. <br />2. All work shell be performed in accordance with this permit and current City of Ev�rett Design and Construction <br />Stendards end Specificationa <br />3. Call Location Underground Serv�ce 48 hra betore you dig. TOLL FREE NUMBER 1•800-424•5555. <br />�j,� Z,r/Sr�L! /2'` CoidC/'E'>E <br />1�,e,�E�.Ay. <br />,S /�,PivEw�aaf/ iJinrrf Ta f�E <br />��/ . � <br />�ioa' /�� .S `/ C�7 <br />ApprovedforConstructio � Date <br />% �:�� � - � �� <br />FNV7(L INSPECTION Date <br />Approved as Construcled <br />everett PUBLIC WORKS DEPARTMENT <br />� 3200 Cedar Street <br />Everett, WA 98207 <br />Phone: 259�ffi!?S $$Q(� <br />Cc�t vc.: T uiC�oE2 <br />f%T G Ef/-rr G�p <br />. <br />ACKNOWLEDGEMENT OF CONDITIONS <br />Tlie undersigned owner/applica�t hereby agrecs to hold and save harm• <br />less the City of Everett from any and all claims for damagec, costs, <br />expenses, or caus�s of action that may arise because of installation <br />and maintenence of the improvemr.nt or other right-of-way use hereto <br />applied tor and turther agrees to remove same upon notice from the <br />City and to replace public property damaged thereby. <br />X 1��:, o� , � �-J <br />Signature of icant Date <br />WORK AUTH IZEO BY THIS PERMIT MUST BE STARTED WIiHIN <br />180 OAYS OF DATE PERMIT IS �SSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />