Laserfiche WebLink
---- � -,:.� . ,.;,:� --_ --- - �..,.J ,•.,,,.� <br /> ./�d �/ ✓ <br /> D2�@ �Or �dS�'t vuoiicworkeaeimn, `b� T7 _ <br /> .4pplicafion For A�ap Dcu1.+ �/e �,9 C� 7 G <br /> ! <br /> PUBLIC WORKS PERMIT �� ���4/ P���=N���=�Ce <br /> Tcidl Fee S <br /> LC55 ApPI.ieP PnN S� <br /> Print or Type Only ea�a�«o�e s 20— <br /> _ ��7C� �� !'. _ (._l7�.r� . / 4�.�G �, ���)6 � �f� �J� �Ti C/�P,E' `�f�/2 '/ <br /> S �/ rs�� <br /> wner Mading Atldress Ciry Lp Phone <br /> i .; <br /> ,/') r <br /> �1E�x-aEi � H, <br /> -App�icant 6lailingAddress City 7ip Phone /-�" <br /> � . <br /> a..- . 4 <br /> Describe Proposed Work ��� �-� C'F `' <br /> I <br /> 7 09 - Z .Nil �� � - W <br /> IProject Address(if known� �„�,f 3� - �%� ,/�_,,,«lm..� � � I <br /> IAttach lour(4) copies ol plans lor proposed woik- Draw to sca�and note ine lollowing as applicable: � <br /> � • Property Lines • Centerline ol street � <br /> i • Outline and dimensions of all existir.g and • Indicate North <br /> I preposed slructures on ihe lol • Show any proposed grading changes <br /> I • Existing and proposed utilities • Sho�v measur��ner.ts � <br /> ��� ' <br /> DO NOT WRITE BELOV� THIS LINE <br /> PERMIT CONDITIONS O <br /> 1.All ca�ls for insper!i_n shall be made 24 hrs.in advance-phone'259$P.i Q � <br /> 2.All work shall be peAormed in accordance with this permit and current Ciry ol�v?i:-t:Design and Conetruction <br /> Standards and Specifications. <br /> 3.Call Location Underground Service 48 hrs.belore you dip.TOLL FREt�JlIh18ER 1•80Q•424•5555. � <br /> 4 . ANY CHANGR TPI TNR DFIVF.WRY CUT M�18'P BF. APPROVTJ� O <br /> ; BY THF,' PUP,LTC WOPK� INSPL'CT�IF- <br /> IS.CONN�CT �WN;;Pnrrp;, '�� Pi1T�i,iC DRAiNAr,F SY,:';r11. L <br /> � 6. KEF.P CITY ti7'RRET6 Cf�FAN F1'1' ALL TIMRS. r <br /> 7 .ANY DAI•fAGS 'Pn THr nftFg A1JD STI�SWALK W7I.,i, RE hRP41NF'1� ♦A <br /> � TO TNFi SATTSFACTT��?1 nF THI? P��Ri�TC �4i�RK;; PRPT. ��� <br /> I O <br /> ! a � <br /> � ; <br /> /� ACKNOWLLDGEMEI . �ONDITIC`�S I <br /> C.Y� The undersigred owneVapplicant h� anrees to Y and save harm� � <br /> less �he City ol �:verett Irom any �� �II claims .mages. costs, ! <br /> � � � ezpenses, or cau.:es of action thal may arise beca� af installation <br /> N��, ��� and maintenanr.e ol the improvement or othpr nghbof-w„y use hereto <br /> ' �-� -90 applied for and further aorees te remove se�c� apun notice Irom the <br /> iApproved lor Con ion " Dale i'.ity and�o ieplace public properry dan-�zge;1 �7creby. I <br /> ���' ' � <br /> ,��=c /� � <br /> � A proved as Consiructed Date -�-�--�-�+--�— 3•�y' "I � � <br /> �gnatwe of Appl�cant Date � <br /> I everrtt PUBLICWORKSDEPARTMENT �VORK AUTHORIZED BY ThIS PERMIT MUST BE STARTED WITHIN i <br /> � 3200CedarStreet 180 DAYS OF DATE PERMIT IS ISSUEO AND THEREAFTER IS TO <br /> Everelt,WA 98201 B[ DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE � <br /> Phone:259�8810 CANCELLED BY THE GTY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAVS DURATION. <br />