Laserfiche WebLink
� � ���� rum�cwo�xsPcrmi . <br /> Date_ f�'- � � T I <br /> AppliCation For o�ao Deni-+ – — <br /> PUBLIC WORKS P�RMIT PUeTaalFeeFeo S — <br /> Less apo�.Fee Paia $ <br /> Balance Due � <br /> Print or Type Orly <br /> J c <br /> <�=�n,�f�►�� ����rti� 1-'t V��+� S�. ��'�'� ��-17 �s�� <br /> pW��e� Madmg Address Cdy Zip Phone <br /> Applicant Mailing Address City Zip Phone <br /> �,--.n ��t/���--C�'� I �((:I'� <br /> Describe Proposed Work � Y'�,�-+� `� <br /> _ � , W <br /> Project Address(il known) � �� ~ <br /> Atlach lour(4)cop�es of plans lor proposed work• Draw to scale and note ihe lollowing as appliwbla: � <br /> • Property Lines • Centerline ol street ♦A <br /> • Outline and dimensions of all existing and • Indicate Norih V� <br /> proposed structures on Ihe lot • Show any proposed giading changes <br /> • Existing and proposed utilities • Show measurements � <br /> DO NOT JJRITE BELOW THIS LIN[ O <br /> PERMIT CONDITIONS <br /> t.All calls for�nspection shall be made 24 hrs.in arvan�:e•phone 259•8810. s� <br /> 2.All work shall be performed in accordance with this permit and current Ciry of Everett Design and Construction ♦ <br /> Standards and Specificaii��ns. <br /> 3.Call Locat�on Underground Service dB hrs.belore you dig.TOLL FREE NUMBER 1•800•42Q•5555. � <br /> O <br /> /,/LfiCLI."GC ���0'��=� �27�t�L{ �� Jl1- �•• ����`F''� � <br /> � �� N <br /> O <br /> a <br /> ACKNOWL[DG[MENT OF CONDITIONS <br /> The widersigned owner/applicant hereUy agrees to hold and save ha•m� <br /> — less the City ot Everett Iwm any and all claims lor damages. costs, <br /> expenses, or cau.^,ns ol action �hat may arise because of inslallation I <br /> and maintenana• of ihe improvement or o�her nghPol�way use hereto <br /> applied br anA '�rther agrees to remove samc upon notice Irom �he ! <br /> APn�oved lor Consirudion Date City and to replace public properry damaged Ihereby. �, <br /> FINAL INSPECTION Date <br /> Approved as Gonstru�Ied Signature ol Applicant Dale . <br /> WORK AUTHORIZED BY TH�.S PERMIT 4lUST BE STARTE-D WITHIN <br /> evemtt FUBLICWORKSDEPARTMENT 1B0 UAYS OF DATE P[F611T IS ISSU[D AND THEREAFTER IS TO <br /> � 3200CedarStreel BE DILIGENTLY PURSUED TO COA�PI Fnf7N THIS PERMIT MAY BE <br /> EverC��.�'dA 9d201 CANC6LLED BY THE CITY UPON ANY STOPPAIiE OF WORK ON THIS <br /> Phon¢259-88�0 PROJECT OVER 90 DAYS DURATION. <br />