Laserfiche WebLink
Date /OIZI ( wdicwoese.rmn• �����7 <br />Applieaticn For in eidq. Dem. • — <br />N. <br />PUBLIC WORKS PERMIT wares Fee <br />d: a: F<e $ <br />O '.e]3 Addl Fee Paid s <br />C3 C VI 1!] eaiance Cue 5 <br />Print or Type Only <br />IL <br />m uD � oa <br />W W W <br />L� �pp� INU83Z>f'1TCD2P <br />Owner Mailing Address �'11y0 � j 5 .. Zip Phone <br />.r 030 Cp U <br />M C D= U <br />3 NA*�4J 16RE5 527-063lo <br />Applicant Mailing Address Cay Zip Phone'- 1 w s <br />Describe Proposed Work �u "U NLEX J:ft "1% "_gfS 1lr�lrlt 'f5 aD 6�7 �qCK) �.J <br />tjJOMOU%&O 14UV ,V000ND lb LQ4Rn� SIMV-e I lNgc L. PART- CaNCA -" 'vl1%WML <br />ME N oggk or- <br />1 M T2 LL <br />Project Address lit known) it <br />Attach four (4) copies of plans for proposed work - Draw to scale and note the following as applicable: S <br />• Property Lines • Centerline of street / f <br />• Outline and dimen lions of all existing and • Indicate North v <br />proposed structures on the lot • Show any Droposed grading changes <br />• Existing and proposed utilities • Shaw measurements <br />DO NOT WRITE BELOW THIS LINE <br />PERMIT CONDITIONS <br />1. All calls for inspection shall be made 24 hrs. in advance - phone 259.8810. t: <br />2. All work shall be performed in accordance with this permit and current City of Everett Design and Construction z <br />Standards and Specifications. <br />3. Call Location Underground Service 48 hhrrs, beforeyoudig. TOLL FREE NUMBER 1-800.424.5555. <br />!� 1/XZi'Lf�tl �lrtw,+91 -C�/L w�� 52P �Zi�c�iLd' .Gr., .C.cu%I a, Lilac-� `S <br />.y J G.• <br />.r�2lU �¢.ia.��6.t tL6a�w�o��' a,l� ,iiiv �u;7LtJ <br />ACKNOWLEDGEMENT OF CONDITIONS <br />Approved as Constructed <br />everett FUBLIC',VORKS DEPARTMENT <br />3200 Cedar Street <br />Ever <br />Evered.'NA 98201 <br />Phone: 259.8810 <br />The undersigned owner/applicant hereby agrees to hold and save harm <br />less the City of Everett from any and all claims for damages, costs <br />expenses. or causes of action that may arise because of installatior <br />and maintenance of the improvement or other right-of-way use heretr <br />applied for and furt%�b'ir��� es��to remove same upon notice from Ne <br />fjry am1'a reolacc�ouLllcarbAefty damaged thereby. <br />WORK AUT'IORIZED 9YAHIS PERMIT MUST BE STARTED WITHP <br />180 DAYS OF`QATE PERMIT 13 ISSUED AND THEREAFTER IS Tc <br />BE D41GENTLY k-f+SUED TO COMPLETION. THIS PERMIT MAY S. <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THI, <br />PRC.IECT OVER 90 DAYS DURATION. <br />