Laserfiche WebLink
' / <br /> Date.�[�(/QU Pubi¢Wods Pe�mll s J�/z /� / <br /> / Applico�ion For Biap.oep�..� ���/4 <br /> PUBLIC WORKS PERMIT Pub1icWprk,Fe� <br /> .o�w�F�a a <br /> �ess noo�Fee ae�n S <br /> Print or Type Only ea�w�«o�, S 2--� <br /> ��{� -l�P.��a S�3Ci /�1G.-�nr [���pr�° �3�/k'�P6�i <br /> Owner MaiVing Address ��� <br /> Y ZiP Phone <br /> _�_ <br /> Applicant Mailing Address City 7_ip phone � <br /> Describe Proposed Work _�� / Si G ���LA i�c_� `�1/�. L(y� �� � <br /> Prolect Address(it known) �3�rT" ' L S i L]IZ. SE. � <br /> Attach lour(4)copies of plans for proposed work- Draw to scale and note ihe Inllowing as applicable: � <br /> • Property Lines • Centerline ol siree� � <br /> • Outline and dimensions ol all exisling antl • Indicate Norih <br /> proposed structures on the lot • Show any proposed grading changes <br /> • Existing and proposed utilities � Sl��ow measurements � <br /> DO NOT WqITE BELOW THIS LINE <br /> PERMIT CONDITIONS O <br /> 1.All calls for inspection shall be made 24 hrs.in advance-phone 259•8810. � <br /> 2.All work shall be performed in accordance wilh this permit and current Ci1y of Everett Design and Construction <br /> Standerds and Specifications. <br /> 3.Call Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1-500-424-5555. � <br /> 4.ANY CHANGS IN THfi DRIVSWAY CUT MUST BE APPROVED <br /> BY TH6 PUBLIC WORKS INSPBCTOR. O <br /> 5.CONN6C.0 UOWNSPOU'PS TO PUBLIC DRAINAGE SYSTHM. <br /> B.KHHP C]:TY STRBS"PS CL$AN AT ALL TIMES. � <br /> 7.ANY DAbfAGH TO THH CURB AND SIDSWALK WILL BE RF.PAIRHD <br /> TO THH SATISFACTION OF THE PUBLIC WORKS DSPT. /_ <br /> V� <br /> O <br /> L.� <br /> ���V ACKNOWLFDGEMENT OF CONDITIONS <br /> _ The undersi�ned owner/a»Iicant hereby agrees to hold and save harm- <br /> less the City ol Everc" �.n any and all claims for damages. costs <br /> expenses, or causes a 'on �hat may arise because ol installation <br /> c anC maintenance oi fl avement or other ri ht�ol�wa use herelo <br /> VVl lcex_.. C9�Z9—�Cl s v <br /> Approved br Cons u�tion applied lor and furth�� .. _es to remove same upon notice hom ihe <br /> / <br /> eate City and to replace p�� �•� cr�perty damagsd thereby. <br /> IG�L � � <br /> ��o� �-- .j ,. <br /> F�NAL INSPECT�ON Uate �lG• <br /> Approve as Construc�ed i a re ol Applicant Date <br /> everelt PUBLIC WORKS DEPARTMENT WOR AUTNORIZED BY THIS PEAMIT MUST BE STARTED WITHIN <br /> � 3200CedarStreet 180 DAYS OF DATE PERNIT IS ISSUED AND THEREAFTER IS TO <br /> Everett,WA 98201 BE DILIGENrLY PURSUED TO CnMPLETION. THIS PERMIT MAY 8[ <br /> Phone:259�8810 CANCELIED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVFR 90 DAYS DURATION. <br />