Laserfiche WebLink
Dzte � �` <� % Pu�l¢WOrkSPC�TiI! __ <br /> � Appl�cation For eia�.oeo��� <br /> PUBLIC WORKS PERMIT PueTotlFee�Pe 5 <br /> Less/p01.Fc,ePaiO S <br /> BalpnceDuc � <br /> Print or Type Only <br /> i � G <br /> � clv� � c � � . �.1. � 57-�a �t�J .�- 3 � y /���u �/r. 1 c�Pr�7T I,�Lc i Z.)`%-�a <br /> Owner Mailing Address C.ty Z�p Phone � <br /> —5 � h, �, <br /> qpplicaM Mailing Address City Lp Phone <br /> Descnbe Proposed Work � �� � � � ��-�� ��� -- <br /> W <br /> Prolect Address(il known) ���y — ����PL/– -- � <br /> Attach four 14) coples of plans lor proposed work- Oraw to scale and note the tollowing as applicabl�; � <br /> � Property Lines • Centerline ol street � <br /> j • Out6re and dimensions oi all eaisting and • Indicate Norih <br />� p�oposed struclures on the lot • Show any proposed grading changes <br /> 1 • ExisUng and proposed utilities • Show measurrments � <br /> DO NOT WRITE BELON�THIS LINE O <br /> PERMIT CONCITIONS <br /> 1.All calls for inspection shall be made 24 hrs.in advance•phone 259•8810. � <br /> 2.All work shall be pertormed in accordance with this permit and current City o�Everett Design and Construction <br /> Standards and Specifications. <br /> 3.Cali Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1•800•424•5585. � <br /> ,��-�-c..z�� _' rq L L�y �Cf r=S S Lc,%'.f /��;f�iL !J6/_ _F O <br />! �'-`F'.E:� G�i/ZfJ�r_F GdAS CCit/[/EwTI� � <br /> <st�rEo ��� /�,���„-.rJ , ti'd oT6�•_`,2 � <br /> D�� /.v /�C vc,� _FX�£PT Fo�< oNc � <br /> y���,s� cvH,c� ,ov�s �; .�/a v,_ /'�c�y a <br /> �<«ss. <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned ownerlapplican�hereby agrees to holtl and save�iarm- <br /> — less the City ol Everetl from any and all claims tor damages, cosis, <br /> expenses. or causes ol action that may arise because of installation <br /> and maintenance of the improvement or other right-of•way use here�o <br /> applied lor and lurihcr agrees to remove same upon noticc Irom ihe <br /> Approved lor Con:truction Date City and to replace publlc pwnerry damaged thereby. <br /> FINAL INSPECT�ON Date <br /> Approved as Constructed S�gnaWre ol AUPGcant Date <br /> WORK AUTHORI7.cD BY THIS PERMIT MUST BE STARTED WITHIN <br /> everett PUBLICWORKSDEPARTMENT �g0 DAYS OF [�ATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200CedarStreet gE DILIGC-NTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Everett,WA 9A201 CANCELLED Bl�7HE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone:259�8810 PROJECT OVEF: 90 DAYS DURATION. <br />