Laserfiche WebLink
Dq�e � �/� �I I � I] � ,r� �r � 1 Publ�ic 1YOfhs PCr��� � � <br /> �� L,� � L L� j I � <br /> L� eiae oeoi.+ <br /> Appiication For <br /> Pi .�BLIC WORKS PERNfIT�:�c1C7�33 :.���W�k,Feo $ �.o. o0 <br /> . ................. <br /> ......._.............. Less Poot Fea i:ie S <br /> .CITY Or E�-c�ET7 BalanceDua s�• �`� <br /> Print or Type Only pt,�''.� �q',rks DccL (��:�/.S <br /> / / � � — , i� i t/i �� r �. '• �/ ��� -��.;/ t <br /> l�( (i /�i/1'(`J'r r � (' , %� :'c ; / ! i"<" � _ — __ <br /> Owner Maihng Address City 2ip Phone <br /> l�l��<� �� Phone <br /> Applicant Mailing Address ���Y Z�p <br /> ' c( -�i � /!;/��' ��r/..'YG'r �� %F'il,�- �� ��� <br /> Describe Proposed Work �����'��j - <br /> W <br /> S p,- � .�... - � �- <br /> Project Address(il kno�vnl — 5��� � / � �� / ��� � , <br /> Atlach four(4)copies of plans lor proposed work- Draw lo scale and nole the 1 owing as applicable: �� <br /> • Property Lines • Centedine uf etreet � <br /> • Oulline and dimensions of all ezisting and �+ Indicale Ncrth <br /> proposed slruclures on the lot • Show any F��oposed grading changes <br /> • Exisling and Froposed utilities • Show measurementc � <br /> DO NOT WRITE BELOW THIS I.INE O <br /> PERMIT CONDITIONS <br /> 1, All calls lor inspection shall be made 24 hrs. In adoance- phone 259•881 5. � <br /> 2. All work shall be perbrmed in accordance with ihis permit and current City of Everett Design and Consiruction <br /> Standards and Specifications. <br /> 3. Call Location Underground Servi�� -9 hrs. belore you dig.TOLL FREE NUMBER 1•800-�24•5555. � <br /> � <br /> �w <br /> �/ <br /> O <br /> a <br /> ACKNOWLEDGEMENT OF CCJNDITIONS <br /> The undersigned owner/applicant hereby aprees to hold and save harm- <br /> less lhe City of Everett from any and all cleims for damayes, cosls, <br /> :�^����_ �� exPenses. or causes of action that maY arise because of insta"slion <br /> 1,.�_r--d; and maintenance ol Ihe improvemenl or other right-ol�way use hereto <br /> applied for and turther agr=es lo remove same upon notice irom the <br /> Apomv d t struclion Date an to replace ublic property damaged thereby. <br /> � ��ZI � � <br /> �IG�, t� Ce- i L i� f'3 <br /> FIN .I CTIO D31e Date <br /> Appwv�d as Consiructed , S' nature of Appll nl <br /> ORK AUTHORI ED BY THIS PERMIT MUST BE STARTED WITHIN <br /> everett 'UBUC WORKS DE�ARTMENT 180 DAYS OF DATG PERMIT IS ISSUED AND TNEREAFTER IS TO <br /> � 3200 Cudar Sireet BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BL <br /> Everett,WA 98201 CANCELLED BY THE CITY UPON ANV STOPPAGE OF WORK ON THIS <br /> Phone: 7`_.�-8815 pROJECT OVER 90 DAYS DURATION. <br />