Laserfiche WebLink
� <br /> Date Z"�d' P�e���wo,�s Pr,m��. p _ <br /> AppliCalion For BIEq.0e0��• r�� � /�C1� <br /> PUBLIC WORKS PERMIT Pu�bcWorkaFce -- <br /> Tolal Fee S_ <br /> Less AO�L Fee PaiO $ <br /> Bnlanre Uue S_ <br /> Print or Type Only <br /> _�0��2� �:�N�i �4� h rr�P�f'nIIP� /QUP_ �VP�ai-� Q�7l1 � ZSQ - �/QQ� <br /> n ner Mailing Address Ciry Zip Phone <br /> �Q�l�Vl Q, <br /> Applican� Mailing Address City Zip Phone <br /> Describe Proposed Wo�k R n w�n��r PX� c K. ✓�CQC�1L+/ I� t�-- /IO�Y TYI �� f(�'1(T/��p <br /> n�7'r-�-� P�tl� ��0'il�� / �—� <br /> W <br /> Prolect Address Iif known) � � <br /> Attach four(4�copies of ptans for proposed work• Draw to scale and note Ihe tollowing as applicable: � <br /> • Property Lines • Centerline ot streel � <br /> � Outline and tlimensions of all existing and • Indicate North <br /> proposed structures on the lot • Show any proposed grading changes <br /> • Existing and proposed utilitie� • Show measurements � <br /> DO NOT WRITE BELOW THIS LINE <br /> Y O> PERMITCONDITIONS <br /> 1.AII calls 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 City of Everett Desig�and Construction <br /> Standards and Specitications. <br /> 3.Call Location Underground Service 48 hrs.6efore you dig.TOLL FREE NUMBER 1•S00•424•5555. � <br /> �1/.dG/G c�XJ�S �,G,��.r tior ���a�,� 0 <br /> �`�3�� � <br /> �� � <br /> O <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersic�ned owner/aUPlicant hereby agrees to hold and save harm• <br /> less Ihe City of Everelt Irom any and all claims for damages, costs. <br /> expenses, or causes ol aclion ihai may arise because ol installation <br /> and maintenance ot Ihe improvement or other righl-of�way use hereto <br /> applied lor and lurlher agrees to remove same upon notice irom the <br /> Approved lor Construction Date Ciry and to replace publ!c property damaged thereby. <br /> F�NAL �NSPECTION Date <br /> Approved as 4onstructed SignaWre ol Applicant Date <br /> everett PUBLIC WORKS DEPARTMENT INORK AUTHORIZED BY THIS PERMIT Iv1UST BE STARTED WITHIN <br /> � 3200CedarStreet 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everett,WA 98201 BE DILIGENTLY PURSUED TO COMPLETION. THIS PEFMIT MAY BE <br /> Phonc:259�8810 CANCELLED BY THE CITV UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAYS DURATION. <br />