Laserfiche WebLink
//--�� a '/1 <br /> � O +(� � �J�t <br /> Det@ � r�oi�owo�ksco, n. 5 <br /> o Application For e��e�o�o�.• � <br /> � PUB�IC WORKS PERMIT PubToteFee`P0 = -- <br /> O <br /> � l¢SSADP�-FeePaid � <br /> Frint or Type Only � 'g��ff]]',g �p � g g S � g g Ba�a�=a o�� s_�d <br /> m m N M M � N N q M � � <br /> M �' N (LJ� <br /> ..+ J � _ <br /> Owner � Mai i Zip Phone <br /> � <br /> g � � � ro� �� � � � � �� <br /> Applicant Mailing Address City Zip Phone .y,� „ <br /> -�f2 1�-�- (��-�t��'� � �,� <br /> Describe Proposed Work � <br /> Proiect Address 1if known) �o ZZ.� — �i ST DfZ � � <br /> Atlach lour(4)copies ot plans lor proposed work• Draw to scale and note the following as applicable: � <br /> • Property Lines • Cenlerline ol street � <br /> • Ou�line and dimensions ol all existing and • Indicate North <br /> proposed structures on the lot • Show any proposed grao�ng changes <br /> • Existing antl proposed ulililies • Shcw measuremenis � <br /> DO NOT WRITE BELOW THIS L1NE <br /> PERMIT CONDI7IONS O <br /> �.All calls for inspection shall be made 24 hrs.in advance-phone 259•8810. � <br /> 2.All work shall be pertormed in accordance with this permit and avrent City ot Everetl Design and Conshuction <br /> Siandards and Specitications. <br /> 3.Call Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1•800•424•5555. � <br /> 4.ANY CH.9NGfi IN THE DRIVEI4AY CUT MUST BE APPROVED O <br /> BY THE PUELIC F!ORKS INSPECTOR. <br /> 5_CONNHCT DOWNSPOUTS TO PUBLIC DRAINAGE SYSTEM. L <br /> 6.KESP CITY STREETS CLfiAN AT ALL TIMES. r <br /> 7.ANY DAMAGE TO THE CLIRB AND SIDfiWALK WILL BE REPALRED �/� <br /> TO THH SATISFACTION OF THE PUSLIC WORKS DEPT. ��� <br /> O <br /> a <br /> ,'l�t� l.GF.NOWLEDGEMENT OF CONDITIONS <br /> r The undersigned o.vner/apHlicant hereby agrees to hold and save hc <br /> less the City of Everelt Irom any and all claims for damages, cc <br /> expenses, or causes cl action that may arise because of install, <br /> and rnain!nnance of the improvemFnt or other �igLt-ol-way use h� ,. <br /> Approved for Cons ction applied lor aatl luriher agiees lo remove same upec noticc: iron �. . <br /> Date Cily and to replace public Groper�y damaged �hereby. <br /> , �'K�/ J ��✓' i% � <br /> FINAL INSPECTION Date �l •-��L"L�-i�— 'f���l <br /> Approved as Consiructed '-SI"gnature ol Applicant �' � Date <br /> everett PUBLICWORKSDEPARTMENT WORK i1UTHORI2ED BV THIS PERMIT MUST BE STARTED WITHIN <br /> � 3200CederStreet 180 DAYS OF DATE PC-Rh11T IS ISSUED AND THEREAFTER IS TO <br /> Everett,WA 98201 BE OILIGENTLY PUfiSUED 1"O COMPLETION. THIS PERMIT MAY BE <br /> Phone:259�8870 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAYS DURATION. <br />