Laserfiche WebLink
�f/s • ��o��v,o,k,P��m�. <br /> Date '� • o�ea u�p� . d'S�/S� �i�— <br /> � Application For <br /> pUBLIC WORKS 1'ERMIT PUELCWorbFco 5 <br /> Tctal Fee <br /> �e5s ApD�FCe PeiO S <br /> Balance Oua 5 <br /> Print or Type Only <br /> � � ' �-�y� y. <br /> � �ue. � (�'� 1�.3 C l/leaG��r�l�� ��i l� ✓�-i�-'� 9 �1��CL� �.�� <br /> "fiL�ln�_ 1 C�y ZiP Phone <br /> Owner Mailmg Address <br /> _5U�7�f� Ciry Zip Phone <br /> Applican: Meiling Address <br /> l+ Op !-�oT��t1r� Can�1 �DU���� A±lo�t/�, <br /> Describe Proposed Work ^I , Q I ( w� (�S <br /> �i C'I,A O�, — <br /> f1 ��1> Nis' �hOE� n L- XiSTING f fiC1D-� � <br /> - E //erc7 v'1 ��� '��Jr f vc'I'e� � <br /> Projecl Address(i� known) — <br /> Attach lour(4)copies ot plans lor proposed work- Draw to scale and note�he following as applicable: � <br /> • Properry Lines • Cenlerline ol slreel <br /> • Indicate North <br /> • Outline and dimensions of all ezisling and � ghow any proposed c�rading changes <br /> proposed siructures on ihe lot � ghow measuremeNs M <br /> • Existing and proposed utilities W <br /> DO NOT WRITE 6ELOW TF115 LINE O <br /> PERMIT CONDITIONS � <br /> 1, All calls tor inspedion shall be mad� 24 hrs.in advance-phone 259•881 5. <br /> 2. All work shall be performed in accordancc with this permit and current City ol [verett Des�gn and Construction <br /> Standards and Specilications. � <br /> 3. Call Location Undergn md Service 48 hrs.betore you dig.TOLI FREE NUMBER 1•800•424-55 . <br /> �ir_1�,� %/i�i;�"C .��c=F/�7�� /�'�iY %E�>�i<c%� O <br /> , �� � <br /> �� / ��� .�!_7 �.w■ <br /> � �/ <br /> O <br /> a <br /> PCKNOWLEDG[MENT OF CONDITIONS <br /> The undersipned owneqapplicant hereby agrees to hclA and save harm- <br /> less the Clty of Everet� irnm any and all claims lor damages, costs. <br /> expenses. or causes ot aclion thal may arise because of installation <br /> and maiNenance ol the improvement or other righhof-way use hereto <br /> applied tor and furiher agrees to remove same upun notice irom the <br /> Appioved br Cons�niction <br /> Date City and to replace public property damaged theieUy. <br /> FINAL INSPECTION Date Date <br /> SignaWre ot Applicant <br /> ApprovedasConstrucle� WORh AUTHORIZFD BY THIS PERMIT MUST BE STARTED WITHIN <br /> cveretl PUBLIC WORI:S DEPARTM�ENT 180 DAYS OF DATE PERMR IS ISSUED A'�D THEREAFTER IS TC <br /> � 3200 Cedar Sireet BE DILIGENTLV PUI75UEG TO C06`PLETION.THIS PERMIT MAY BE <br /> Evare�L WA 98201 CANCELLED BY THE CITY UPON ANY STOPP�G[OF WORI<ON THIS <br /> Phonc: 259�8875 PROJECT OVER 90 �A1'S DUHATION. <br />