Laserfiche WebLink
�8t@�.yn^/ �� r1, <br /> LL/ Public Worke Permii II <br /> Appiication For eiea oec�.s�� �' n� <br /> PUBLIC WORKS PERMIT PUDTaIaIFeeF� s '' <br /> . Lett�00�Fea P�iE S _ �I <br /> Balance Due S� <br /> Print or Type Only �li <br /> �� �l r fi F 1�It I I(120 I���' l��f'� � ��-.�'� �r��G� . <br /> Owner Mailing Address City Zip Phone <br /> �h L��J ���h_ .�rn,�t �, �r��� 4 s�a� � a sg- � ��� <br /> Applicant Mailing Address City Zip Phone <br /> Describe Proposed Work T"Y� U')r 1 /� ����'/ � J / � �.11W I <br /> Project pddress(if known) � � l lol ) �� ���c.._ �� � � <br /> � <br /> Attach four(4)copies of plans for proposed work- Draw to scale and note the following as applicable: � <br /> • Property Lines • Centerline of street � <br /> � Outline and dimensions of ali existing and � Indicate North <br /> proposed structures on the 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•881 5. � <br /> 2. All work shall 6e performed in accordance with this permit and current City of Everelt Design and Construction <br /> Standarils and Specifications. <br /> 3. Call Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1•800•424•5555. � <br /> �U,�� i�:•o��-- !Z'��,o.,,�Wo� ��z$"_ ��`/8 7 O <br /> C� � <br /> � <br /> O <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The unGarsigned ownr.r/applicant hereby agrees to hold and save harm- <br /> less the City of Everett from any and all claims (or dam�ges, costs„ <br /> ezpenses, or causes of action that may arise because of installation <br /> and maintenance of the improvement or other righFof�way use hereto <br /> applied for and further agrees to remove same upon notice Irom the <br /> AFProved for Construction Date City and to replac p lic roperty damaged the�eby. <br /> � <br /> FINAL INSPECTION Date <br /> Approved as Constructed Signat Applicant D,te <br /> everett PUBLIC WORKS DEPARTMENT WO THORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> � 3200 Cedar Street 78 DAYS OF DA7E PERMIT IS ISSUED FND THEREAFTER IS TO <br /> Everett,WA 98201 BE DILIGENTLY PURSUED TO COMPLETION.THIS PERMIT MAY BE <br /> Phone: 259•8815 CANCELLED HY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAYS DURATION. <br />� <br />