Laserfiche WebLink
Date �3 � ' Y <br />Hpplicalion Fi.r <br />PUBLIC WORKS <br />Print or Type Oniy <br />Describe Prol <br />,,s.�,�,:. ,�,..��. <br />o�ao o<�, . �'I-� � 3 � Y <br />P E R M I T I NuOLc Work� Fee s — <br />totd Fee <br />Lne App� Fee Pa�E $ —� <br />Baie+ce Due S <br />.3Kd <br />Zip <br />rnone <br />^^ � a,'a �.i `/� - �2 �7 <br />�o�� <' r� ���lo N� !�7 — ��Q,4 - <br />. Mailinq Address <br />Cdy ZiP Phone <br />_ _�Project Address (i1 known) <br />� <br />Attach four (4) copies ot Plans for proposed work � Draw to scale and note 9 Cen�terline ol stPee� aGle: <br />• Property Lines • Indicate Ncrih <br />• Outline and dimensions of all ezisting and � Show any proposed orading changes <br />proposed slrucWres on the lot � Show medsurements <br />• Existing and G�oPosed utilities _ <br />.... ..,.r,.���r� oci nwTNIS LINE <br />PERMIT CONDI710NS <br />1. All calls for inspection sha�l be made 24 hrs. in advance � nnone 259•881 5. <br />2. 'rll work shall be performed in acwrdance with this permit and curreN Giry ol Everett Design and Construction <br />Slandards and Specifications. <br />3. Call Loca��on Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1•800•424•55 . <br />Gpprnc�°d lor Cons�ru�.Iion <br />� �1 �."` �<��� <br />�" <br />Date <br />FINAL INSPECTION Dale <br />Apn�oved as Constructed <br />��vrrett PUBLIC WORKS DEPARTMENT <br />� 3200 Cedar Slreel <br />Everefl. WA 98201 <br />Phone-259-8'.315 <br />1'��w„� i <br />�?.�NI���. <br />� � ��� . 8'� <br />� <br />� <br />��/� <br />V♦ <br />0 <br />0. <br />:.GKNOI:LED�B.iLNT OI" CONDITIONS <br />Th�� unde�, ��9ned owner/applicant he�eby agrees to hold and save ha�m� <br />Icss ihe Cdy of Everetl trom any and all claims tor damages, costs, <br />exoenses, or causes of action thal may arise because ol installation <br />and maintenance of the improvement or other right-ot-way use hereto <br />applied for and lurther agrees lo remove same upon notice from the <br />City and to replace public property damaged thereby. <br />Date <br />Signature of Applicant <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERIv11T IS ISSUED AND TNEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COt.1P�[TION. THIS PERMIT A1AY B[ <br />CANCELLED �V THE CITY UPOi: -�� i�" STOPf'�GE OF \VORK O�J THIS <br />PFOJ[GTOVER90DAYSDU��"� t��l. <br />