Laserfiche WebLink
Date k,/dw�+� <br />i <br />Application For <br />PUBLIC WARKS P�RIVIIT <br />Print or Type Only <br />ng <br />� <br />Maumg <br />Describe Proposed �h'ork <br />Gity <br />Prolect Address (il knownl � r/'� — ����C�[>Z.4<u � � QC�•F ___ <br />anach four 141 coDies of plans lor proposed work • DraH� to scale antl note Ihe following as applicable�. <br />• Property Lines <br />• Outline and dimensions ot all existing and <br />proposed sVuclures on the lo� <br />• Ezisting and proposed utili�ies <br />��ibl�[. l\'nrAs I`.•rn1 � • //` �l /�(� /��/� <br />E�i�� De�i . �1��V-�-1-" _ <br />/ <br />Puebc Woiws ice S <br />im.i r�� <br />less/nr� �eePa�n 5 <br />Calnnu• D��r .S •'�C �O — <br />zs zc� �s3 - <br />Phone <br />Phone <br />• Centerline of sir �ei <br />• �ndicale iJorth <br />• Show any proUo�ed gradiny changes <br />• Show measurements <br />PERMIT CONDITIONS <br />1. All calls for inspection shall be made'4 hrs. in advance - phone 259•8810. <br />2. All work shall be peAormed in accordance wilh this permit and current City of Everett Gesign and Co�struction <br />Stendards and Specifications. <br />3. Call location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-80d•424-5555. <br />7 <br />'�, �y,zn.� �k�.2T�`:� �'c,a/ L=c�7Z�� c-,.�,,�c�>.��al'� �o✓v <br />��rd s �-.�. �_, � .� 3. � � �%��� � ��.�� <br />�,�,,v s���� r�` � ���� � <br />C1 �i1�/� l�� yl..^� '/�' <br />Approved for Con ruclion �� ��e <br />i�%� �t���� `P'l y"� <br />FINAL INSPECT�Of� Date <br />Approved as Constructed <br />evc� ��t PUBLIC\NORKSDEPARTMENT <br />3200 Cedar Slreet <br />�' Everett WP. 35201 <br />Phom '��U10 <br />ACKNOWLEDGEMENT OF CONDITION i <br />� <br />O <br />The undersigned owner/applicant hereby agrees 1- ��ol:l .�nd save harm� <br />less the Gdy ol Everelt I�om aoy and all claims 'or ds.mages, cusis. <br />expense., or causes of ar.�io� �hat may ai�se beca.ise uf installation <br />and maintenance ol the in�provement cr �It.er nght-o.�way use herelo <br />applied lor and IurU�cr agrees lo �emove same upon notice Irom the <br />City and �o replace puhhc prooerty damaged �herehy. <br />%Gc�x�•..�_ �� �o..�� S z�/-K9 <br />Signa�ure ol Apphcant � Date <br />WORK AUTHORIZED BY'�iIIS PERM:T MUST BE STARTED WITHIN <br />180 DAYS OF DATE PEf 'AIT IS ISSI�ED AND THEREAFTER :S TO <br />8E DILIGENTLY PIIRSIIED TO COM^LETION. THIS PERMIT MAY BE <br />CANCELLED BY ThIE CITY UPON ANY STJPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAVS DURATION. <br />