Laserfiche WebLink
�8t@�•/�'� PuplicWorkaPermR+ � �+ <br /> Application For BiC9�Depl.• <br /> PUBLIC V1/ORKS PERMIT PuercworksFee y�. o„ <br /> .ot.�F�a s-- <br /> Lesa ADG�Fee PeiE S <br /> Bslence Due S r '' � U <br /> Print or Type Only �7�D <br /> � bA-�E wA-`K�n I� o Ro����F-��K�t Eu��-�r� �8�0 � <br /> Owner Mail�ng Address City Zip Phone <br /> �L�'/�ES(,.� �TM FSLba IA/ '� 13ot( 4�3 Woop ��vvi ��C 4� -z7Z �G8 -573� M <br /> Applicent Meiling Address City Zip Phone � <br /> Deacrlbe Proposed Work _1�-�-G y /� � L° E S f t-O 2 /�/� IU fjWG L l. T A1 � <br /> N N <br /> H '•1 <br /> ProJect Address(if known) � � � � e � I� e � � � <br /> Attach four(4)copies ot plans lor proposed work• Draw to scale and note the following as epplicable: � '� � <br /> � Property Lines • Centerline of street � � <br /> • Outline end dimensions of all existing and • Indicate Morth ''� <br /> proposed structures on tha lot � Show eny proposed grading changes z <br /> • ExistinB and proposed utilitfes • Show measurements � � y <br /> DO NOT WRITE BELOW THIS LINE � <br /> O � � <br /> PERMIT CONDITIONS � � � <br /> 1. All calls for inapection shall be made 24 hrs In adve�ce- phone 259•881 5. <br /> 2. All work shell be peAormed in accordance with this permit and current City oF Everett Decign and Construction <br /> Standards end Specificatlona ri <br /> 3. Call Location Underground Service 48 h�s. before you dig,TOLL FREE NUMBER 1•BOO•424•5555. � � <br /> o � <br /> � • � <br /> � �y <br /> O ~ <br /> N <br /> a � <br /> H <br /> n <br /> m <br /> ACKNOWLEDGEMENT OF CONDIT�ONS <br /> The undersigned owner/applicant hereby agrees to hold and save harm• <br /> . . less ihe City of Everett from any and all claims for damages, costs, <br /> . / expenses, or ceuses of action Ihal may arise because o1 installation <br /> � ��� � �/�_ F y and maintenance of the improvement or other right•ol�way use heroto <br /> appliei for and furthe� agrees to remove same upon notice from the <br /> pproved for Coi struction � �a e City and io replace public property damaged ihereby. <br /> `-�/�✓� 4�'�- s_Z -a-� -1� � P� �'y <br /> FIN CTION '� . (1 " � � Date ��� �"� <br /> Approved as Constructed � . Signature f Applicant Date <br /> everett PUBLIC WORKS DEPARTMENT WORK A THORIZED BY THIS PERMI7 MUST BE STARTED WITHIN <br /> � 3200 Cedar Street 180 DAYS OF DI1TE PERMIT IS ISSUED AND THEREAFTER IS 70 <br /> Everetl,WA 98201 BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Phone:259•6815 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAYS DURATION. <br />