Laserfiche WebLink
Date�/C�Q Pu�l<WatsPmmns[y�. <br /> Bia9.0ep1.s�y_ ��r <br /> Applicalian For � <br /> PUBLIC V�/Q�KS PERMIT PuGLCWo�ksFee `, -- <br /> Tnlal Fce <br /> Loss AOP�Foc PaiC ��' <br /> Balance Oue � <br /> Print or Type Only <br /> S�,,,y{ <br /> pW�.�x� t f('� �=��o- 7�o fr� .S� s,�. -�- 93a�o �z�-3 yP�� <br /> �. Mailing Atldress Gry Lp Phone <br /> A;�p�icant Mailinq,4ddre,s City Zip Ph�ne <br /> DescribePioposedWork __ 7a�n "� ;,'YI»L�`+�.v��A'�� '�'✓ •���I��f�'-"`LJCh1��- <br /> -- W <br /> Project Address(if known) ��a 7 .�%��P T/`d � � Z � <br /> AtlacY�feur(4) copies of plans lor proposed work- Draw to scale and note the following as applicable: � <br /> • Proper�y Lines • Centerline of streel /A <br /> • Outline and dimensions of all existing and • Indicate North V� <br /> proposed struclures on the lot • Show any proposed gradinc�chanc�es <br /> • Existing an� preposed u�ilities • Show measuremenis � <br /> �� DO NOT WRI'fE BF.LOW THIS LINE <br /> PERMIT C04DITIONS O <br /> t.All calls Ier inspection shall bz made 24 hrs.in advance-phone 259•8810. �\ <br /> 2.All work snall be pedormed in accordance with this permit and current Ciry ot Evereft Dnsign and Constiuclion ♦ <br /> Standards and Specifications. <br /> 3.Call Location Underground Service 48 hrs.before you dig.TOLL FReE NUMBER 1-8C;0•424-5555. � <br /> / <br /> j�U.�rL/G CUo-/z,�f ��iT /��oT ,��c�, `�"/S���a O <br /> �� <br /> � <br /> � <br /> 0 <br /> a <br /> ACKN04VLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees to hold and save harm- <br /> less die Cily ol Everetl from any and all claims for damages, costs, <br /> expenses, or causes of action that may arse because ol installalion <br /> and maintenance of ihe improvemenl or olher right-of-way use hereto <br /> applied lor and furthei agrees to remove same upon notice Irom the <br /> Approved for Construction Date City and lo replace public pro�erty damaged Ihereby. <br /> FINAL INSPECTION Date <br /> Approved as Constructed Signalu�e ol Applicant Date <br /> WORK ��.UTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> everett PUBLICWONKSDEPARTMENT 1g0 DAYS OF DATE PEfiM1T IS ISSUED AND THEFEAFTER IS TO <br /> � 3200CedarSireet BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BC- <br /> Everett WA 98201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON TfiIS <br /> Phunc:259-6810 PROJECT OVER 90 DAYS DURATION. <br />