Laserfiche WebLink
Date ���� �t� P05TING MAR 0 7 tnn- <br />Z 9 .S %� Application For <br />PUBLIC WORKS PERMIT� <br />Print or Type Onl;� <br />Sno.iomisn Cou��ty Public <br />� r.: _ <br />,- r, .; ;,; <br />�'1 r�, r.i <br />�; ^:r� <br />i9 �': <br />r �i -- <br />PoDi¢ Worxe vermn • / � � �7 <br />BiEy Deo�. • <br />Publit Wods <br />iot�l Fee <br />leas AOC�� Fee PUC i <br />n r. ,eaience0ue a 60�— <br />�, �- <br />4' �. -' PUD Contact: <br />f.i <br />,,; Jim Simpson <br />������ memny Hoaress r,- �. Q�� r- �� . r- Z� _ Phone <br />..,.. r (< U� c.l V� ��il <br />O W L7 /i .._ l9 � ��. 7 <br />O 1— CJ `.. �—i r.J Gl rn ��� <br />(Same as Above) " � �' �, � � ^ _� �Y 7_4338 NOSON <br />f7 'lr -3 L' ii !1.. Yl I11 (1:1 f�J <br />Applicant Mailing Adtlress City Zip Phone <br />Deacribe Propo6ed Work L_3i ��plil¢ and i' Im�TovemQ�S <br />Project Address (il known) <br />Attach four (4) copies of plans for proposed work - Draw to scale and note the following as applicable: <br />• Property Linea � Centedine of st�eet <br />• Outline an0 dimensions of all existing and • Indicate North <br />proposed structu�es on the lot • Show any proposed grading chenges <br />• Ezisting and proposed utilities • Show measuren� � ds <br />PERMIT CONDITIONS <br />1. All calla for Inspection shall be mede 24 hre. in advance • phone 259•8810. <br />2. AII work shall ba parformed in eccordance with this permit and cunent City of Everett Design and Construction <br />Stenderds and Specifications. <br />3. Cell Location Underground Servica 48 hrs. before you dig. TOLI FREE NUMBER 1•800�424•5555. <br />J�, ��2o7lt�n.tn� � � �Oxt� <br />(7y A/,. �ci �Z/3Z C/¢� C7YL <br />�, �--- <br />���I� PUBLIC WORKS DEPARTMENT <br />3200 Cedar Stref+t <br />Everett, WA 98201 <br />Phone: 259-8870 <br />/QF�Y �22��.1- a��T7Xd/ <br />ia - Y- yi <br />ACKNOWLEDGEMENT OF CONDITIONS <br />W <br />� <br />� <br />� <br />The undersigned ownerlapplicant herebp agrees to hold and save harm• <br />less the City o� Everett Irom any and ell cl; ims tor damages, costs. <br />ezpenses, or causes ol action that may arise because of instal�ation <br />and maintenance of ihe in,provemeM or other right-obway use hereto <br />applied for and further agrees to remove same upon notice irom the <br />City and to replace public prope`rty damaged thereby. <br />. � \ --�— <br />�i=T ��' <br />ol Applicant <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DIL�GENTLY PURSUED TO CGMPLETION. THIS PERMIT M.4V BE <br />CANCELLED BY THE CITY UPON P.NY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />