Laserfiche WebLink
/� �]['� ✓ <br /> Date_.j1..LL(l� PuCLc Wo�ks Pe. �� —��Z <br /> Application For BiEB�DepL• <br /> PUBLIC WORKS PERMIT Pu„TotaFeeFeo $ <br /> Le:s AOoI.Fae Paid S�—�r <br /> Balance Duc $ ��� <br /> Print or Type Only � <br /> �D�1�U l l�10� (�2r.��'� � � n n�u �d� <br /> � �.r <br /> Ow er Mailing Address C�ty Zip Phone <br /> 'qppiicynt� Mailing Address City Zip Phone <br /> Oescribe ProFosed Work �1 '�- <br /> -- - ---- W <br /> Projec: .ddiess lil known� �S�O- YYJA�c _F S T. _ � <br /> A!tach four�� ��opies of plans lor proposed work- Oraw to scale and note the followinr�as applicable: � <br /> � • , ;nperty Lines • Centerline ol sheet � <br /> ! Outline and dimensions of all existing and • Indicat�; North <br /> proposed structures on the lot • Show 3r,y proposed grading changes <br /> • Existing and proposed utilities • Show measurements � <br /> DO NOT WRITF. BELOW THIS LINE � <br /> PERMII CONDITIONS <br /> 1.All calis for inspection shall be made 24 hrs.in advance•phone 259-8810. � <br /> 2.All work shall be performed in accordance with this permit and current Ciry ol Everett Design and Construr,tion <br /> Standards and Specifications. <br /> 3.Call Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1•800•424•5555. � <br /> � O <br /> 7 <br /> � � <br /> � <br /> O <br /> a <br /> AC�(NOWLEDGEMENT OF CONDITIONS <br /> � The undersigned owneryapplicant hereby agraes to hold anA save harm- <br /> less lhe City ol EvereU from any and all claims for d;mages, costs, <br /> -� /� expenses, or causes ol action that m-; arise because of installation <br /> �_LC� {t� /D i/�8 and maintenance of �he improvement or other righi-ohway use hereto <br /> �O/�'D% '� T applied lor and turther agrees to remove same upon notire from the <br /> Approved for Constru ti � Date Cily and to;eplace Uu61ic aroperty damaged thereby. <br /> ��'_ a �-s/i ---��r t - - <br /> FINAL INSPEC710N Date - <br /> Approved as Constructed 5ignature of Apphcant� ate <br /> WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> evere[t PUBLICWORKSDEPARTMENT �g0 DAYS OF DATE PERMIT IS ISSUFD AND THEREAFTER IS 70 <br /> � 3200CedarStreet BE D'1..IGENTLY PURSUED TO COMPL�TION. THIS PERMIT MAY BE <br /> Everetl,WA 98201 CANCELLED BY Tf 1E CITY C°ON ANY STOPPAGE OF WORK ON THIS <br /> Phone:259�8H10 PROJFCT OVER 90 DAYS DU9ATION. <br />