Laserfiche WebLink
' '_1�p �- <br /> Date_I_L_L.i�0 �~' Publit Worha Pe��� <br /> Application For Biep.oeo�.• � <br /> PUBLIC WORKS PERMIT PVoTolalFoeFee s <br /> �eas,iooi Fee re��e S <br /> Belance Uue S <br /> Print or Type Only <br /> CY1i�� (`��12_I gr`� �i��"����1J1 �'�-5�� <br /> Owner Mailing Address � City 2ip Phone <br /> C� l'�,st ��s ��-�� ,q��tJ�l'�a��i���i11� qf������..�ia33 <br /> Applicent Mailing Address CityT— Zip Phone <br /> Describe Proposed Work � � � , f11 11 <br /> W <br /> Pro�ect Address(if known) � <br /> Attach four(4)copies of plans lor proposed work-Drew to scale and note the tollowing as applicable: � <br /> • Proper+y Lines • Centerline of sireet <br /> • Outline and tlimensions ol all existing and • Indicate Norih � �i <br /> proposed strurtures on the lot • Show any proposed grading chanqes <br /> • Existing and proposed utilities • Show measurements � I <br /> DO NOT WPITE 6cLOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 1. All calls for inspection shell be made 24 hrs.in advanc=•phone 259•881 5. � <br /> 2. All work shell be pertormed in accordance with ihis permit and current City of Everett Design and Consiruction <br /> Standards and Specifications <br /> 3. Call Location Urderground Service 48 hrs.before you dig.TOLL FREE NUMBER 7•800•424•5555. � <br /> V�U� F��c�U12�L� ///3/�7 � <br /> ���� � <br /> � <br /> 0 <br /> a <br /> � <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undr.rsigned owner/applicanl hereby a�rees to hold and save harm• <br /> less the City of Everetl trom any anA all claims for dameges, costs, <br /> eapenses, or causes ot action that may arise because of installation <br /> and maintenance of the improvement or other right-ohway use hereto <br /> applied �or and turther agrees to remove same upon notice irom the <br /> Approved tor Conslruction Date Ciry and to replace puhlic property damaged thereby. <br /> FINAL INS�ECTION Date <br /> Approved as Constructed Signature of Applicant Date ��i <br /> everett PUBLIC WORKS DEPAfiTMENT WORK AUTNORIZED E3Y THIS PERMIT MUST BE STARTED WITHIN ' <br /> � 3200 CeAar Street 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTEP IS TO I <br /> Everett,WA 98201 BE DILIGENTLY PURSUED TO COMPLETION.THIS PERMIT MAV BE I <br /> Phone: 259�8815 CANCELLED BY THE GTY UPON ANV STOPPAGE OF WORK ON THIS ' <br /> PROJECT OVER 90 DAYS DURATION. <br />