Laserfiche WebLink
�_ _ ___ - . , - -- <br /> ,. t" <br /> Date $ � '�i <br /> Public Woiha Perm <br /> ApplicationFor Biae�Deot+ � �1Q�,3_ <br /> PUBLIC WORKS PERMIT P�DTotelFeeFea s <br /> . less AoO�Fee Pe�a $ <br /> Print or Type Only ea�a��e o�e s <br /> �G� �, .CP✓O�n�rl 3��a-d T,��1;�2L4-.Le. G✓P�Pt� ��L .zsa-1 i„ . <br /> Owner MaJm9 Address City Zip Phone <br /> � <br /> Applicant Mailing Address City Zip Phone <br /> Desc�ibe Proposed Work �cd nl I, rn. T2] PK�.c/� � �`� p� I <br /> Project Address(if known) �y � �i /ri�rt�i� '+ � <br /> Attach lour(4)copies ot plans for proposed work- Draw to scale antl note ihe iollowing as applicable: � <br /> • Property Lines • Centerline of street � <br /> • Oulline and dimensions of all existing and • Indicate North <br /> proposed slructures on the lot • Show any proposed grading changes <br /> • Exislinp and proposed utilities • Show measuremems � <br /> DO NOT WRITE BELOW THIS LINE <br /> PEqMIT CONDITIONS O <br /> 1. All calls lor inspection shall be made 24 hrs. in advance- phone 259•881 5. � <br /> 2. All work shall be perlormed in accordance wilh this permit and current City o� Everett De;ign and Construction <br /> Standards and Specifications. <br /> 3. Call Location Underground Service 48 hrs. belore you dig.TOLL FREE NUMBER 1•800•424•5555. � <br /> � f�,�in�T N�T .�E�G%�E O 8 -!�- 8� O <br /> �� L <br /> `1�^ <br /> V♦ <br /> O <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees to hold and save harm- <br /> less the City of Everett Irom any and all claims lor damages. costs, <br /> expenses, or causes o: action ihat may arise because ot installation <br /> and maintenance of the improvemenl or other righ�-of-way use hereto <br /> Approved lor Consiruction Date applied for and lurther a�rees to remove same upun nolice trom the <br /> City and to replace public property damaged thereby. <br /> FINAI INSPECTION Date <br /> Approved as Constructed Signature of Applicant Date <br /> evemlt PUBUC WORKS DEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> � 3200 Cedar Street 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everett.WA 98201 BE DILIGENTLY PURSUED TO COMPLETION. THIS PEFMIT MAY BE <br /> Phone: 259�8815 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAYS DUFATION. <br />