Laserfiche WebLink
, <br /> � <br /> ���,,� �,>,��n/- ,.�.� <br /> Date-111?�1��� ✓ PuoLc Works Pe ��. <br /> � Application Fo� aiog oeo�.•������— <br /> PUBLIC V4/O�KS PERMIT PublitWorksFee - <br /> ;����Fea s— <br /> LesS Appl.Fae PaiE $ _ <br /> Print or Type Onty Balance Due S_ __ <br /> �G��� A��� 5����-���n� ��� �r� iq�� Avr �5� ���� �� ,� <br /> Ownrr Mailing Address City Zip � Phone <br /> Applicant Mailing Address City Zip Phone <br /> Describe Proposed Work ���� � � � �'�� <br />� � ��.KC�� l , ��L�n <br />��� � �1 /� /� W <br />����� I Project Address(if known) � ��� 1 .��� �`�f �!� /'-1V � <br /> Attach four(4)copies of phns for proposed work• Draw to scale and note the following as applicable: � � <br />��I. • Property Line� • Centerline of sireet � <br /> • Outline and dimensions of all existing and • Indicate North � <br /> proposed strucWres on the lot � Show any proposed grading changes � <br />�' , • Existing and proposed utilities • Show measuremenis � . <br /> I <br /> ' DO NOT WRITE BELOW THIS LINE <br /> li � PERMITCONDITIONS O <br /> 1.All calls for inspection shall be made 24 hrs.in advance-phone 259•8810. � . <br /> ' 2.All work shail be peAormed in accordance with this permit and current City of Eveiett Desi9n and Construclion <br /> � StandardsandSpecitications. <br /> 3.Call Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1•800•424•5555. � ' <br /> 1�C`�T� V'���' ;i r�� - Q <br /> � �.. � <br /> ��88 �- ' <br /> �� � <br /> � <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees to hold and save harm- <br /> — less tne Cdy of Everelt irom any and all claims for damages, costs, <br /> expenses, or causes of action that may arise because of installation <br /> and maintenance of ihe improvement or other righFo(-way use hereto <br /> applied for and furiher agrees to remove same upon notice from the <br /> Approved for Consiruction Date City and to replace public property d�maged thereby. <br /> FINAL INSPECTION Date <br /> Approved as Construcled Signature of Applicant Date <br /> everett PUBLICWORKSDEPAR7MENT WORK AUTHORIZED BY TIiIS PERMIT MUST BE ST�RTED WITHIN <br /> � 3200CedarStreet 180 DAYS OF DATE PERMIT �S ISSUED AND THEREAFTER IS TO <br /> BE DILIGENTLY PURSUED TO COMPLETION.THIS PERMIT MAY E;L <br /> Everett,WA 98201 CANCELLED BY THE CITY UPON ANY STOPPAuE OF WORK ON THIS <br /> Phone:259-8810 PROJECT OVER 90 DAYS DURATION. <br />