Laserfiche WebLink
��� <br />O � x <br />9HN <br />H�� <br />re c] <br />oH� <br />�tly� <br />H <br />'Z <br />�HC <br />H^�g <br />Y,V � <br />t"y� <br />gyy <br />nCCy <br />[�1 <br />HQ� <br />Date � � " <br />PUr�LIC <br />� <br />`� � I <br />Print or Type OnIYr u; <br />�I <br />�:j in <br />S. _.. _ r <br />u� <br />�/ - 35-z�)-�- <br />ApplicaUon For <br />WORKS PjE�RP�STTNG � �.� " <br />O O(� J O O O � i i'' i G.' I <br />o..�o c: � , �, <br />O`u P'� .:P CJ O C� !'� Cl O <br />p� n� U. �. �-..+1 D-• Pl . i b) I� <br />p .n ur [� fn o ] <br />.a�'`" ��ccn. � "' � =' .ir; �`c- <br />__._ o; a o��.i 1; 1.-- v� `. <br />� �wfi�n�aw� <br />� <br />Applicant Mailing <br />..�':+v�7� <br />o c� o �— i�� <br />S.-+t� Q S <br />�y .-1 YC j U <br />Descrihe Proposed Wark 'y�`�� J� �� <br />� <br />Prolect Address (il known) <br />Zip <br />Pu�hc Woiha Paemil � JI � �� ' <br />Bl�o oeo��+� � <br />Pu01ic Workf Fao $ <br />Totnl Fee <br />lesf N00� Fae PaiC S �7 <br />oei,nco ouo S L� ^ <br />-- �-��v� <br />Atlach lour �4) copies of plans for proposed work • Draw to scale and note the following as auPlicable: <br />• Property Lines • Centedine oi street <br />• Outline and dimensions of all existin9 and • Indicate Norih <br />proposed slruclures on the lol • Show any proposed grading changes <br />• Existin9 and proposed utilities • Show measurements <br />Phone <br />PERMIT CONDITIONS <br />1. All calls for inspectlon shall be made 24 hrs. in advanco • phone 259•8810. <br />2. All work shall be pertormed in accordance with ihis permit and currenl City o! Everett Design and Consiruction <br />Standards und Specilications. <br />3. Call Location Underqround Service 4B tirs. before you dig. TOLL FREE NUMBER 1•800•424•5555. <br />� <br />�.AQ Yl��eo `7-9-9� <br />Approved for Consiruction Date <br />Ol� G'���y` <br />FINAL INSPECTION Date <br />Approved ns Construcled <br />�PUBLICWORKSDEPARTMENT <br />3200 Cednr SVeel <br />Everetl. WA 90201 <br />Phonc:259�8810 <br />ACKNOW�EDGEMENT OF CONDITIONS <br />W <br />H <br />� <br />� <br />�1 <br />• <br />�� <br />� <br />� <br />O <br />a <br />The undersigned owner/applicant hereby a9rees ;o hold and save harm� <br />less the City ol Everelt Irorr. any and all claims lor damages, costs. <br />expenses. or causes of action Ihat may arise because ol inslallation <br />and mainlenance ol the improvemenl or other ri9h4ol�way use hereto <br />applied lor and turther agrees to remove same upon notice fmm thc <br />Cily and to replace public propertY damaged thereby. <br />��, � � �'��� �"�"''� <br />iywlure 0 Applitan Dale <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMITIS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTIY PURSUED TO COMPLETION. THIS PERMIT MAY 8E <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJ[CT OV�R 90 DAYS DURATION. <br />