Laserfiche WebLink
i <br /> / v�ni�c worws aerm � <br /> Date ��SL� �}t7_ <br /> Biao Deo�.�---� <br /> App�ication For <br /> PUBLIC WORKS PERMIT PUOTo�Fee��� s <br /> Less Roo��Fee Pa�E S— — <br /> Balence Duc S <br /> Print or Type Only <br /> r� ;�i�n„-� � r�� ,� ��� I.���1-rnn�rr�' ��r�ti� ��-4`��I <br /> Owner <br /> `J Mailing Address City Lp Phone <br /> qpplican� Mailing Address City Zip Phone <br /> Describe Proposed Work ` � '� �f ' ^( A���� ( �`��/ ��I��I� ��� <br /> q,�,�' W <br /> Project Address(if known) ���G�1��" " '��� � <br /> � <br /> Attech lour(4)copies of plans lor proposed work-Draw to scale and note Ihe following ac applica6le: � <br /> • Property Lines • Centerline ol street <br /> • Outline and dimensions ol all ezisting and • Indicate North <br /> proposed strucWres on the lot • Show any proposed grading changes <br /> • Ezisting and proposed utililies • Show measurements M <br /> W <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS � <br /> 1.All calls for inspection shall be made 24 hrs.in advance•phone 258•8810. <br /> 2.All work shall be pertormed in accordance wilh this permit and current City of Everett Design and Construction <br /> Standards and Specifications. � <br /> 3.Call Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1•800•424•5555. <br /> r^r`T r�rC�,�If� y�2��8 O <br /> `� � <br /> � <br /> � <br /> a <br /> ACKNOINLEDGEMENT OF CONDITIONS <br /> 7he underslgned owner/appllcant hereby agrees ta hold and save harm- <br /> less the City of Everett Irom any and all claims lor damages, costs, <br /> expenses. or causes ol action that may arise bacause of installetion <br /> and main�enance ol ihe improvement or other righl-ul�way use herelo <br /> — applied lor and turiher agrees to remove same upon notice Irom Ihe <br /> Approved tor Construction Date City and to replace puUlic properry damaged ihereby. <br /> FINAL INSPECTION �a1e Oate <br /> ApD�oved as Consiructed Signature of Applicant <br /> WORK AUTHORI2ED BY THIS PENt+1;T M:�7 BE STARTED WITHIN <br /> everett PUBLICWORKSDEPARTMENT �g0 DAYS OF DATE PERMIT IS ISSUED AND TF!E9EAFTER IS TO <br /> � 3200CetlarStreet BE DILIGENTLY PURSU[D TO COMPLETION. THIS PERMIT MAY BE <br /> Everett.WA 98201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone:259-8810 PROJECT OVER 90 DAYS DURATION. <br />