Laserfiche WebLink
Date/ Q S^ <br /> Pu�lic Works Permit r '�����J� �+ <br /> Application For Bltlg.Depl.e_�Si /S3`_L� <br /> PUBLIC WORK� PERMI`T �'u�licWorksFee <br /> Tolal Foe 5 <br /> LessAppL Fee Paia S <br /> Pflnt Of TypB Only eaia�cooue S ZCJ U—�— <br /> go8'�8' <br /> ��a�-P l-' �('. T���;` 2h o1d I Sr i�i' L' Pfj' /Lld//,'_()e��J�3"I d a'� <br /> Owh�r Mailing Address Cit�� Zi Phor.e <br /> s � ,� fa. s � ,� <br /> Applicant Mailing Address Ci�y Zip Phone <br /> Describe Proposed Work _ /.3_ c�[ � �L /U C�. � �T � P <br /> /lJ f�27- /O ���( � <br /> Project Address(if known) �f`. .S f— � <br /> Attach four(4)copies of plans for proposed work- Draw to scale anG nole the following as applicable: � <br /> • Properry Lines • Centerline of street � <br /> • Outline and dimensionc of all existing and • Indicate North <br /> - proposed slrucWres on the lot s Show a�iy proposed grading changes <br /> • Existing and proposed utilities • Show measurements � <br /> DO NOT WRITE DELOW THIS LINE � <br /> PERMIT CONDII'IOMS � � <br /> 1. All calls for inspection shall be made 24 hrs. in advance- phone 259•881 5. � <br /> 2. All won�shall'�e performed in acrordance with ihis permit and current City of Everett Design and Consiruction <br /> Slanda•,1s a,�d Specificalions. <br /> 3. Call Location Underground Service 48 hrs. before you dig.TOLL FREE NUMBER 1•800•424•5555. � <br /> � ,�,oF��.��.c �s P.e�.t�.�T�y �,��,��,�f.� �.�.�� ,.� o <br /> ��'."� CGNOiTC/+� ANy' l�dn'/d� TU /i s%�A[,G BE <br /> .l'c P�i,�EU ,e�fi 7ffE A�i��iG��l/T � <br /> �� G�QOitiCy o�J T.y� 1 oT s'�;GLL B� .bi,�: Sc� Ti/.QT �A <br /> �('�i:l1•CGdjf.� �.U.uO/-/ �f/�GG it/GT .Sitai?�c.� Tic .�L`JdLEn/T ��� <br /> L OTS� O <br /> a <br /> ACKNOWLEDGEMENT OF COMDITIONS <br /> The undersigned owner/applicaN hereby agrees tc hold and save harm- <br />' less lhe City ol Everen irom any and all claims for damages, wsts, <br /> /` / expenses, or causes of action that may arise because of installation <br /> �2�1'� /"�'� 9� 9 ,� and maintenance of Ihe improvement or oiher ric�hpof�way use hereto <br /> applied for and further agrees to remove same upon noiice from �he <br /> Approv?d for Constr ction Date City and to replace public property amaged thereby. <br /> FINAL INSPECTI N � �f-tI' ` �� pa�e / <br /> Approved as Constructed r `-' Signature o PPlican D t� <br /> everett PUBLIC WORKS DEPARTMENT WORK A THORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> � 3200 Cedar Sireet 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />� Everett,WA 98207 BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Phone: 259�8815 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAYS CURATION. <br />