Laserfiche WebLink
_ +, <br />��1 <br />Date�c�� `x-' <br />yk: <br />� � <br />AUpIICi1�lOO FOf <br />PUBLIC WORKS PE�iMIT <br />Print or lype Only <br />'�J <br />Malling <br />' �` <br />un <br />Pubbc Wo�Ms Amm�t • I +q���//c�� <br />pi�9 UCGi + . �1—"ur/--- <br />v��,�,�,va,�,F�o 5 <br />ro„�.�� <br />Less Ano� �er Pa�J S <br />oai.,o,:r000 S <br />Applican! titailing AdAn:ss Cily Zip Phone <br />Descnbe P�oposed Work _ ��II V� O�.L.LLIE-� � <br />J <br />Pro�ecl Address (if knownl � "3 "� — =�-l=='-- +-'—�"-" <br />qt(ach lour I41 copies ol plans for proposr.tl work - Draw to •,cale and note the loilowinc� as <br />• Properry Lines <br />• Oulline and tlimen5ions ol all existing and <br />proposed struclures on Ihe lot <br />• Exisling and proposetl utihties <br />• Centeiline ot streel <br />• Indicate North <br />• Show any proposetl grndine� chanc�es <br />• Show measurements <br />LI <br />PERMIT CONDITIONS <br />1. All calls lor inspec�lon shall 6e made 24 hrs. in odvance • phone 259•8810. <br />2. All work shall be pedormed in accordance wilh Ihis permit and wrrent Ciry ol Evere�t Design and Conslmction <br />S�andards and Specilications. <br />3. Call Locntion Underground Service 48 hrs. belore you dig. TOLL FREE NUMBEF, �-800•424•5555. <br />�'l 'C� Y�E'C� I �P_ �U <br />Approved lor Consiruction ���e <br />FINAL INSF'ECTION Date <br />Approved as Constructed <br />evc�ett PUBLIC WORKS DEPARTMENT <br />� 3200 Gedar Street <br />Ever�il, WA 99201 <br />Phonu:259�8810 <br /><=�r�;(s��L'_ •�?U-�9 <br />1 <br />ACKNOWLEDG[MENT OF CONDITIONS <br />Z <br />� <br />The undersic�ned owner/applicant hereby agrees lo hold and sava harm� <br />loss the City of Everett Irom any and all claims lor dama�es, costs. <br />expenses, ar ca�ises oi actian Ihat may arise hecause al inslallation <br />antl mainlenance of lhe improvement or olher iighbobway use hereto <br />applied lor and luriher agrees to remove same upon notice Irom the <br />Clty and to replacc puhlic pronerty tlamaged Ihereby. <br />Si�nature ol Applicant Dale <br />WORK AUTHORIZED BY THIS F'ERMIT MUST BE STARTED WITHIN <br />1B0 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT tv1AV BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />�r. <br />