Laserfiche WebLink
Date�% " P,��,�����,o..,�,,,m��. Zy <br /> � niaq �co� • L' `�`�� <br /> ��______ <br /> ApPlicatien Foi <br /> PUBLIC WORKS PERMIT °°°'","°""`° ---- <br /> ,��,�.�� s- <br /> lcssRno� ferPam 5 <br /> �alanceUue 5 <br /> Print or Type Only <br /> Cj iln IAIA /� 7 � � c� �) �hr �iL(� 2 �\��—� '0�•P�'�- Yil �C � 3T7 ' j7.s�— <br /> Ow er Madmg A dress � -��Phone <br /> S� I�e�lnl�_e�g � �.Yi �-�X tiiyS t= „n.o� q..�-Zd� �iSa—ii.� i <br /> Applitant Mailing Address Ci�y ZiP Phone <br /> Descnbe Proposed Work <br /> W <br /> Prolect Atldress lil known� 77�� �I � � �� '�A �� — ~ <br /> Attach lom(A) coples ol plans for proposed work� Draw tu scale and note the following as apUlicable: � <br /> • Property Lines • Centedine of street � <br /> • Outl�ne and dimensions ot all eaisling and • Indicale Norih <br /> proposed structures on Ihe lot • Show any proposed grading changes <br /> • Existing and proposed utilities • Show measuremen:s M <br /> W <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 7.All calls for inspection shall be made 24 hrs.in advance•phone 259-8810. � <br /> 2.All work shall be pedormed in accordance with this permit and wrrent Cily oi Everett Decign and Construction <br /> Standards and Specifications. <br /> 3.Call Location Underground Service 48 hrs.betore you dig.TOLL FREE NUMBER 1•800-424•5555. � <br /> N�, �J i�.�l �-� �� O <br /> � <br /> , � <br /> r � ��.�- �� � ��� A <br /> i � - � S - �: � � <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicanl hereby agrees to hold and save harm� <br /> less the City of Everztt Irom any and all claims lor damages, costs. <br /> expenses. or causes �! aclion that may arise because ol installation <br /> and mainlenance of the improvement or other ngh4ol�way use herelo <br /> apphed for and lunher agrees to remove same upon notice irom the <br /> Approved lo�Consiructicn �a�� Crty anA ro replace public prop�erty damaged ihereby. <br /> FINAL INSPECTION Date Date <br /> Approved as ConsirucleA Si9nature c 4pplicant <br /> WORK �UTHORIZED BY THIS PERMIT MUST B[ STARTED WITHIN <br /> everrtt PUBLIC WORKS DEPARTMENT 1B0 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200CedarSlreet BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT fdAV BE <br /> Everett.WA98201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone:259-8810 PROJFC7 OVER 90 DAVS DURATION. <br />