Laserfiche WebLink
Date�U^� <br />Appl�Cation For <br />PUBLIC WORF:S PERMIT <br />Print or Type Only <br />adiny ANtli�•ss <br />c <br />c�ir : m <br />`�l'11� --- — <br />APPhCant M11aJ�ny ACdirs: Cily Zip <br />r,e,,,�-. �;o�n.. P..��y..����{ C/J�/ ` �G /. ✓ <br />einn o�,n� , ._C.� �-,{�LF�. <br />,,.,��,�,�,�,�, «a <br />,o�.,� F�,_ s _ <br />less ano� Fpe Paip 5 f'� <br />Elalam:r Dua $ `�— _ <br />Phonc <br />Phunc �---- <br />Descnbc Proposed Work _ ___ _�v ���� `-�� I 1 F -�-�� �/ � � n <br />— - - -- — 7('1(.0 � ) �I� � [L�_�� � L , <br />Prolect Address Id knownl --��� 7 n�� —`���� y fh <br />Attach lour �41 copies ol U��ns lor proposed work - Draw to scale and note ihe �ollowing as apphcahle: <br />• F�9perry LineS <br />• OuY.ine and dimensions ot . II eais6ng �nd <br />proposetl s;rudures on thc �ot <br />• EniSUng and proposatl utihties <br />• Ccnterline ot slreet <br />• Indicate North <br />• Show any proposetl gradin9 chan9e5 <br />• Show meaSUremenlS <br />PERh11T CONDITIUNS <br />'. All calls lor inspection shall be made 24 hrs. in advance - phone 259•O8� 0. <br />2. All work shall be pertormed in a:wrdance with Ihis permit and currenl City of Eve�etl Uesign ai.d Consiruction <br />Standards antl Specilications. <br />3. Call Loca�ion Underground Serv�:e 48 hrs. belorz you dig. TOLL FREE NUMBER 1-500-424•5555. <br />!,�� ,� �,/�� <br />Approved (or GonStru �i0n _ � a�e <br />�c� / <br />f�'/G�3G_��._. iu. /2-d�i <br />FINAL INSPECTION Daie <br />Approved as Constructed <br />evere�t PUBLIC WORKS DEPAPTMENT <br />� 3200 Cedar Street <br />Everett. WA 9fl201 <br />Phone�.259�8810 <br />ACKNCWLEDG[MENT OF CJNUITIONS <br />W <br />� <br />N <br />� <br />O <br />� <br />� <br />O <br />a <br />The undersigned owner/applicant he�eby agiees to hold and sace harnr <br />less the Gty ol Everett Irom any and all claims for dama9es, cosls. , <br />expenses. or causes ol 2d,on that may arisa because ol installation �, <br />and maintenance ol the improvement or other righbof-way usa hereto � <br />applieA lor and furiher agrees to remove same upon notice from ihe ' <br />Ci1y and to repl. ce public property dama9ed Ihereby. 'I <br />� , <br />�: i , �� �, <br />,�-�--,.�.- `� i � <br />i9ndlure ol A P� 'ant , atc <br />WORK AUTHORZED BY THIS PERNIT MU57 BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS IS�UED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED 10 COh1^LETION. THIS PERMIT MAV BE <br />C!1NCELLED BY THE G�7Y UPON AN" STOPPAGE OF WORK ON TI11S <br />PROJ[CT OVER 90 DAV;, DURATIO, � <br />