Laserfiche WebLink
� <br /> Date�i � <br /> �'S • • <br /> PuOM1c WorMs Permit a 7�--- <br /> ApplicationFor emeoeo�.=_�S �57� �S— <br /> PUBUC WORK;i PEF�MIT P�b��=W�,k,F�a <br /> iotaiFee S <br /> less/opLFcePaid $ <br /> Print orType Only B.,�a�=�o�� s <br /> ��!�� --'T��/> / ir-,T��,e' Fd'�,E-e-/i s�s�v,,, � <br /> wner Malling Adtlress Cily Zip Phone � t <br /> � <br /> (^�-!)��;;>v�c.n. _STs.�� ii9'`'�.9�•��ri� L�;S��-,-� ��.,%seY ;»��!-1.�1z.. <br /> Applicant Mailing Address City Lp Phone <br /> �i <br /> Describe Proposed W�rk c�� X s� L�yS�.C'iF,F,� �h� �r/(,�,% a� X�2 sh p,/J <br /> ,r <br /> Project Adtlress(if knox�n) �i�� �.C�IS/ �i� '"'�iC��� � <br /> Attach lour(4)copies ol plans lur proposed work- Oraw lo scaie and note the following as apPlicable: � <br /> • Pioperty Lines • Cent=dine ol street � <br /> • Outline and dimensions ol all existing and • Ind;� � North <br /> proposed slructures on�he lot • Show any proposed grading changes <br /> • Existing and proposed utilities • Show measurements <br /> DO NOT WRITE BELOW THIS LINE � <br /> PERMIT CONDITIONS O <br /> 1. All calls for inspection shall be made 24 hrs. in advance-phone 259•88�5. � <br /> 2. All work shall be performed in accordance with this permit and current Ciry of Everetl Desiyn and Constiuction <br /> Standards and Specilicalions. <br /> 3. Call Location Underground Service 48 nrs. belore you di�.TOLL FREE NUMBER 1•800•424•Sb55. � <br /> /��C� f�i.>�-�C- l�/��/_'�S j F<'r,�iT ,�'Fc�Ui�f'E-Q � <br /> ��" �//��- �,- <br /> � <br /> 0 <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/apn�icant hereby agrees fo hold and save harm- <br /> less the City of Everett Irom any and all claims lor damages, costs, <br /> expenses, or causes of action that may arise because ol installation <br /> and maintenance ol ihe improvement or other right-ol-way use hereto <br /> Approved lor Consiructwn Date applied lor and lurlher agrees to remove same upon notice Irom ihe <br /> Ci�y and to replace public properiy damaged thereby. <br /> FINAL INSPECTION Date <br /> Approved as Constructed Signa�ure of ApPlicant Date <br /> everett PUBLIC WORKS DEPARTMENT WORK AUTHORIZED BV THIS PERMIT MUST BE STARTED WIiHIN <br /> � 3200 Cedar S�reei 180 DA\'S OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everett,WA 98201 BE OILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Phone: 259�8815 CANCELLED 8Y TI1E CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAYS DURATION. <br />