Laserfiche WebLink
r <br /> , <br /> � H <br /> ��� . <br /> >HCn <br /> �� � <br /> �y� Date�� v�m���w�,ws c�,m,� O '- 4�.S.S <br /> � ���j <br /> � n � eir.q o��n� • �. /�_ <br /> � Application For <br /> � �g PUBLIC WORKS PERMIT °°°"°w°,�=°n� <br /> ,o�,�F�� s_—. <br /> �r � lc:.st,�pi Fer V�iif 5 — <br /> 9 y a„i.,�-�o��_ 5 �O�� _ <br /> �y Print or Type Only <br /> H <br /> gy <br /> � � <br /> ��y � �'�=J�tth �lr�r�� 5�31 ��� �� �J l�'���k i ! ��,U �- �—<3_ P� <br /> �" Owner Mailing AAdress City 7.Ip Phone <br /> y�y ppGcan� Mailing Addrrss City Lp Phone <br /> Describe Proposed Work c� . — <br /> —_ — � <br /> PruIeClAddresslilMnown) _. ���� ' i-3n��G�/_�. � _ � <br /> Attach four(4)cOpir,s o� plans lor proposed work� Draw�o scnle antl notc the lollowing as applicable: � <br /> • Property Lines • Centedine ol sVeet /A <br /> ! Ovtline and dimensions o� all existing and • Indicate Norih V� .. <br /> proposetl sirucWres on�he lo� • Show any proposed c�rading changes <br /> '�1 • E.isting and pro;osed utilities • Show measurement: � <br /> ' ' DO NOT WRITE BELOW THiS LINE O <br /> � <br /> '�t PERMIT CON[11TION5 <br /> 1.All calls for insa::ction shall be mao^2a hrs.in advance-phone 259•8810. � <br /> 1 ' 2.All wcrk shall be oedormed in accordance wilh this permil and current City of Everetl Design and Conslruction <br /> � Stan�ards antl Specifications. <br /> 3.Call Location Underground Service 42t hrs.betore you dig.TOLL FREE NUMBER 1•800•424•5555. � <br /> � � <br /> 1_� � <br /> �_� a <br /> �_� <br /> ACKNOWLEDGEMEN?OF CONDITIONS <br /> � \�, The undersiynetl owner/applicant hereby agrees to hold and save harm� <br /> less the City of Everett from any and all claims for tlamages. costs, <br /> / expenses. or causes of �ctlon that may arise because ot installation <br /> —��(// ��n,�,,_/� I/ i dnd ^�ain�enance ot �he improvement or olher righPof�way use herelo <br /> �-i✓'��� L ''�'-"" � � �7 �y� ap�•.� �. �or an �Y�her agree remove same upon notice Irom �he <br /> Appmved tor Consirvc�ion Date �/�p ' ;,�y r las(�publ c pro en damaged thereb . <br /> �'� J��'� (O-��� I /�� 2 g <br /> FINAL INSPECTIOIJ Date � �M/�L / <br /> Approved as Constructed Si�nature ol pplicant ��e <br /> everett PUBLICWORKSDEPARTMENT WORK AUTHORIZED BY THIS IT MUST B S ARTED WITHIN <br /> � 3200CedarStreet 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everett,WA99201 BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Plione:259�8810 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT nVER 90 DAYS DURATION. <br /> e <br />