Laserfiche WebLink
Dale��� �„���,�wo��.P��m,�. _ _ <br /> . / /� <br /> Application For ema ocn� • __��J�17�. <br /> PUBLIC WORKS PERMIT �°°°°W°��°F�° � : <br /> Tntel fex a— <br /> loss r1no�.Fee Pn d S_ . <br /> Print or Type Only Bo�a�=Qo�,� s_____ <br /> ��rokac�� <br /> I_,,•a{�n�. Cva6 �a��'�. ('l fcv E� N�arl �id2o`-� 3�l7-i/�3 -- <br /> Owner Mniling Address Ci�y Zip Phone <br /> xT111P - <br /> Applicant Mailing Address City Zip Phone <br /> 1 /� /� <br /> DeSCribe Proposed Work �A�1fiN �' IM�I(C L141�1j / � � � u f�.� G T E ���,.,,..����7,!`i.IS , <br /> /L�F �=� �t' �W� .�71/�,�P/` �.,.C� <br /> i / <br /> W <br /> Proiect Address(if known) � <br /> Attach lou�(4) copies ol plans for proposed work- Draw to scale and note the following as applicable: �� <br /> • Property Lines � Cenlerline of street � <br /> • Outline and dimensions of all ezisling and � Indicate Norih <br /> proposetl structures on the IOI • Show any proposed grading changes <br /> • Ezisting antl proposed utilities • Show meesuremenis � <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> t. All calls for inspection shell be made 24 hrs. in advance• phone 259•887 5. � <br /> 2. All work shall be performed in accordance with ihis permit and current Ci[y ol Everett Design and Construction <br /> Stendards and Specifications. <br /> 3. Call Locetion Underground Service 48 hrs. before you dig.TOLL FREE NUMBER 1•B00•424•5555. � � <br /> �BL./G Lv�7.cc5 ��E.t'i..,.i/✓G'i /f£CiCi;.PEU `j���/tr`'� O <br /> ��.� � <br /> r/ I <br /> O <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees to hold and save harm- <br /> -- less Ihe Ciry of Everetl Irom any and all claims for damages, costs, <br /> expenses, or causes ol action ihat may arise because of installation <br /> and maintenance of the improveinent or o�her right•ol-way use hereto <br /> applied for and furiher agrees to remove same upon notice Irom the <br /> Approved lor Conslruction Date Cily and to replace public property damaged thereby. <br /> FINAL INSPECTION Date <br /> Approved as Constructed Signature ol Applicant Date <br /> everett I'UBLIC WORKS DEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> � 3200 Cedar Sireet 180 DAYS OF DATE PERMIT IS ISSUED AND 1'HEREAFTER IS TO <br /> Everett,WA 98201 BE DILIGENTLV PURSUED TO COMPLETION. THiS PERMIT MAY BE <br /> Phone: 259�8815 CANGELLED BY THE CITY UPON ANY STOPPAGE OF W(1RK ON THIS <br /> PROJECT OVER 90 D�YS DURATION. <br />