Laserfiche WebLink
Date.��� = �' � � - V <br /> PupLc Works Permil � <br /> Applicafion For <br /> PUBLIC W B��aOeo� • <br /> ORKS PERMIT Publ�cWorhaFeo <br /> FEB 2 B 1997 To1alFee s �.3_�_ <br /> PrintorTypeOnly TO POSTING �esiRDplFeePalas__ <br /> Baiance Due f <br /> —�� <br /> Owner Mailing�ddress I �� �� � <br /> City Lp <br /> Phone <br /> A , , LK � l�vl.� �r �7D'� �,I b ULI�° q�CY� <br /> Maihng qddress ���Y <br /> Zip Ph n <br /> Descrihe Proposetl Work _�'� �� 1 1 VI� ��0�—�� <br /> / b All <br /> Project Adtlress(if known) O/S � � <br /> . �` r <br /> Attach four(4)copies of plans lor proposed wo�k- Draw to scale and note tlie lollowing as ayplicable: � <br /> • P�operty Lines <br /> • Oufline and dimensions of all existin�and � Centerline�f streel � <br /> . proposed structures on the lot � �ndicate Norlh � <br /> . • Existing and proposed utilities • Show any proposed grading changes <br /> . • Show measurements <br /> DO NOT WRITE BELOW THIS LINE m <br /> PERMIT CONDITIONS O <br /> 1.All calls tor inspectlon shall be made 24 hrs.in advance-phone 259•$810. <br /> 2.All work shali be peAormed in accordance with this permit antl current City of Everett Design and Gonsiruction <br /> Standards and Specifications. � <br /> 3.Call Location Underground Service 4B hrs before you dig,TOLL FREE NUMBER 1•8pp.424-5555. <br /> '�"' /"�v,� a,p,,r-oc,.d ,p,��•-,1' </�+�� � <br /> // r / Z-z 7 -�r3 O <br /> � <br /> � <br /> � <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> _ The uiidersigned owner/applicant hereby agrees to hold and save harm- <br /> less the City ol Everett from any and all claims for damages. costs, <br /> expenses, or causes ol action Ihat may arise because ol installatlon <br /> �- pz 5 and maintenance of ihe improvement or other nght•ohway use herelo <br /> Ap r e (pr G nstr �'n 6ate applied for and lurther agrees to remove same upon notice from the <br /> � � Cily and lo replace public proper ayed thereby. <br /> FINAL INS CTIO� ' ^�� <br /> Approved as Constructed Dat _�_�^ p n <br /> Signature ol � r <br /> plicant Date <br /> everett PUBLIC WORKS DEPART�4ENT WORK AUT RIZED BY THIS PERMIT MUST BE STARTED WI7'HIN <br /> � 3200CederStreet 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everett,Wq g8207 BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Phone:259-8810 CANCELIED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAYS DURATION. <br />