Laserfiche WebLink
9�?.�'��S i <br />Date / � � v'i ��j" �'/ �G �,C a9G <br />Application For <br />� PUBLIC WORKS PERMIT ._ �''"�� <br />Print or Type Only <br />,-'or'f � <br />Describe Proposed Work <br />Project Address (it known) <br />/J 2. <br />Address <br />Address <br />Ej�€Q � ( / <br />City <br />Ly,��W��,�� <br />City <br />L, <br />Pu�licWarkSPe�mi�+ ��_��J <br />B�Og. Dept • <br />PubhcWoikSFeo $ <br />Total Fen <br />Less Appl Fee Paid � ����� <br />$ CJCJ <br />Balance Due <br />Attach lou! (4) copies of plans for proposed work - DraK• to scale and note� Ce�l�erline ot street able: <br />� Property Lines • Indicate North <br />• Out�ine and dimensions of all existing and � Show any proposed gr3ding changes <br />proposed s!r�clures on the lot � Show measurements <br />• Existing and proposed utilities <br />� <br />rnone <br />��L ,��3 9• <br />Phone <br />FI�L I � _ <br />PERMIT CONDITIONS <br />t. All calls tor inspection shall be made 24 hrs. in advance • phone 259•881 5. <br />2. All work shall be performed in accordance with this permit and current City of Everett Des�gn and Construction <br />Standards and Specifications. <br />3. Call Location Underground Service 48 hrs. belore you dig. TOLL FREE NUMBER 1•800•424•5555. <br />�l.t Ti/E fY'r.c�%i�'�//.7 , /•JivTs� GF f�/��K/�L�ti- �Si'�'.-'FS <br />c5'f/�'l[' �t� g - L '; \ <br />Cc/Tf/ .A.docir /1' Z idil�) <br />� cSTi: iP / <br />C�C 9S 6 9,Si'i/9G T, <br />J. f y! :'�v[r L���'v ��� �•t� %/E 'SL L Ey <br />s��j� f/ �c 2'L O{ l'orn�9CT6v <br />Approved as <br />everett <br />� <br />� /��%/,'��1/G-� l�D.t/c f�in' <br />�-. <br />2 � T;�, �,r .ys,��,�� <br />d <br />PUBLIC l4'ORKS DEPARTMENT <br />3200 Cedar Slreet <br />Evere�t, W498201 <br />phone:259-8815 <br />7 <br />W <br />H <br />� <br />� <br />� <br />O <br />� <br />� <br />O <br />v,-;,�.�i�%�- A,PF� ss�9c c � a� � <br />�/L � <br />�a �' � � <br />:� , <br />ACKNOWLEDGEME�dT OF�CdNDITION5��� - <br />The undersigned owner/applicat�t hereby agrees 10 hold and save harm- <br />less the City ol Everett Irorti`nn� �and- ell claims lor damages, costs. <br />ezpenses, or causes of action that may anse tiecause of installalion <br />and maintenance of ihe improvement or other fic�M�obway use hereto <br />applied lor and lurther agrees to remove same upon notice irom the <br />City and to replace public property damaged lhere6y. <br />f � <br />/ t � -�7�—� % <br />f plicant Date <br />80RDA STOO DATE PERMIT ISESSUED AND THEREAFTEP IS TU <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJEGT OVER 90 DAYS DURATION. <br />