Laserfiche WebLink
i <br /> I <br /> � <br /> Date��'1 ^ <br /> Pub1c Works Permil• <br /> � Application For eiao.oeai.. r�����Q(p� <br /> i PUBLIC WORKS PERIVIIT P��IicWorkaFea <br /> � Totai Fee S <br /> Leas Appl.Fee PaiE s <br /> IPrint or Type Only e.�.���o�e s <br /> � � / �D �� l06 7 F�p��t� �.�7ry! <br /> Owner _"�� 7L'�' J�/� <br /> Mailing Address City 2ip Phone <br /> �Q .11/)Nf� ('�e�!-�o 1�7 /�.,�4�'�- E�P,Ar1 4��c� as9 9�� <br /> Appl�cant Mailing Address City Zip Phone <br /> _�Describe Proposed Work �� �p��� �j,��� <br /> Pro�ect Address(if known� � � � <br /> Attech four(4)copies of plans for proposed work• Draw to scale and note the lollowing as applicabie: � <br /> • Property Lines � <br /> • Centerline of street � <br /> • Outline and dimensions of all existing and � Indicate North <br /> propoaed structures on the lot • Show any proposed grading changes <br /> • Existinp and proposed utilities • Show measurements <br /> DO h0T WRITE BELOW THIS LINE � <br /> P[RMIT CONDITIONS O <br /> 1. All calle lor Inspection shall be made 24 hrs. in advance• phone 259•8815. <br /> 2. All work shall be pertormed in accordance with this permit :.nd wrrent City of Everett Design and Construction ' <br /> Stenderds and Specificetions. <br /> 3. Cali Location Underground Service 48 hrs. belore you dig.TOIL FREE NUMBER 1•BOO-424•5555. <br /> �l/GPC/G L�9/' � <br /> �' �/Y.�/�/1/OT��C,i.P�d� /�����/ O <br /> �i%���"" � <br /> � <br /> O <br /> a <br /> ACKNOWLEDGEMENT OF CON�ITIONS <br /> The undersigr.ea owner/applicant hereb>dqrees to hold and save herm- <br /> less the City of Everett irom any and all claims lor damages, costs, <br /> expenses, or causes o1 2ction that may arise because ol installation <br /> and maintenance of the improvement or other right-of-way use herefo <br /> Approved for Construction pa�e applied for and further agrees to remove same upon notice from the <br /> City and to replace public property damaged thereby. <br /> FINAL INSPECTION Date <br /> Approved as Constructed Signature of Apphcant Date <br /> everett PUBLIC WORKS DEPARTMENT WORK AUTHORI2ED BY THIS PERMIT MUST BE STARTED WITHIN <br /> � 3200 Cedar S'reet 180 DAVS OF DATE PERM17 IS ISSUED AND THEREAFTEP IS TO <br /> Everett, VJA 98207 BE DILIGENTLY PURSUED TO COMPLE710N. THIS PEFMtT MAV BE <br /> Phone: 259-8815 CANCELLED BV THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVEH 90 DAYS DURATION. <br />