Laserfiche WebLink
Date P�ei��wo,w.r�.,,�,.i� ---- --- <br /> Application For ume oeo�..._ __-_____ -__.—_ <br /> PUBLIC WORKS pERMIT "°°��°W°��„°° — <br /> ,o���«, s <br /> ��,�,.��� ��..�•.,,� $— <br /> �,��. „���,,. s <br /> Print or Type Oniy — <br /> Dm,�/ ���.0 �3{�I/%vrJ __;,nu�. �2 2`9'- lpiZ� <br /> Owner MadingAAd�ess C4y Zin Phone <br /> q�p���a���-- Maeing Addre55 City Zip Phone <br /> � ` r / //— ' <br /> Descritie Proposcd W�rk �Y{1P'� � -T�, ��LJy���� `' " ��'-�� <br /> i <br /> Projec!Address�ilknownl _ ��10 Vl� ��c.-•P(�r-z� " � <br /> � <br /> Attach lour�4) r.op�es ol planc lor proposed work- Draw to scale and note lhe lollowing as applicable: � <br /> • Property Lines • Cente�lme ol street � <br /> • Outline and dimensions ot all ezistiog and • Indicate No�ih <br /> proposed structures on Ihe lot Y Show any proposed gmding changes <br /> • Existing and proposed utilities • Show measuremenis � <br /> DO NOT WRITE BELOW TIiIS I INE O <br /> PERMIT CONDITIONS <br /> t. All calis lor inspeclion shall be made 24 hrs. in advance- phone 259•881 5. � <br /> 2. All work shall be perlormed in accordance wdh�his permit and turrent City of Everelt Devgn and Construction <br /> Stnndards and Specilications. <br /> 3. Call Location Underground Service 48 hrs.belore you dig. TOLL FREE NUMBER 1•800•424•55Li5. � <br /> No �U����� ��,�.�s ��2��r .���v�,eccl� Q <br /> j����sr ������- ,�c,�i.�- n�-' ,� sFv�� �/� <br /> y?<-,���T V� <br /> �. 0 <br /> `�`�✓ � <br /> �f-ZS a <br /> l+.CKNOIVI[DGEMENT Of'CONDITIONS <br /> The undersi�netl ewner/aPPiicant hrrehy cgrces�D hold and sav�harm- <br /> --- !ess ihe City of Everell irom any and all claims for damages. costs. <br /> expenses, or cause5 ot action Ihat may arise because o� installation <br /> and malntenance ol the improvement or other righl-obway use here�c <br /> applied br and iorther agrees to iemove same upon notice Irom ihe <br /> Approved lor Gonsiructiun Date City and to replace public property JamageA thereby <br /> FINAL INSPECTION Date � <br /> Approved as Conslructed Signature ol Applicant Date <br /> WORK AUTHORIZ[D BY TIiIS PENMIT MUST BE STAl�TED WITHIN <br /> e��eren PUBLIC WORKS DEPARTMENT 1B0 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200 Cedar Slreet BE DIL�G[NTLY PURSUED TO COMPL[TION. THIS PERMIT MAY BE <br /> Evcrell.WA 98201 C,4PJC[LLf_D[3V THE CITV UPON ANY STOPPAG[OF 6VORK ON THIS <br /> Phoac: 259�BU15 PRpJFCT OVF_R 90 D.4YS DUF.ATION. <br />