Laserfiche WebLink
� �'= y �"7�0�� <br /> Date. . �� a 7 L P��e�,�v,o,wsPe,m�� �� <br /> Application For �.� TO POST!�!� Irlg Dept��� <br /> PUBLIC WORKS�ERMIT PJOTo�alFeeFee $ /7�a-=—� <br /> a <br /> � LessAno� FeePaiG $ N <br /> O l <br /> �� � o �-� � aa�a�«o�� s ;l8L <br /> Print or Type Only � c� � �n .-� a, <br /> � <br /> o r%• � ni c;, c.i <br /> r, r, rav� t� w <br /> w ui .-i L7 P� <br /> ' I „L 11�� �� �( Jl,( ! .�1�4/C�.�{'�n'l l . /�1 .C'i q ,�,C!�(J� �-7—D�2 j <br /> Owner Mailing Add ss � � LL ^ Cd ? <br /> � (oa c•i r� u� oa �: Y �P Phone <br /> �� o • � :.= . c� <br /> C'J O M— H /— W <br /> �'^�� \ O �i- 3 3 i i 2 <br /> Y1 n � � n. aoc� <br /> Applicant Mailing Address City Lp Phone <br /> Describe Proposed Work 1 I— / A / l A �, �� <br /> Project Address�it known� DG�2�^ J`��AL�'S- G✓ � , <br /> � <br /> Attach four(4)copies of plans for proposed work- Draw to scale and uote the lollowing as applicable: � <br /> • Property Lines • Centerline of sireel � <br /> • Outline and dimensions of all existing a+�d • Indicate Norih <br /> proposed structures on ihe lol • Show any proposed grading changes I <br /> • Existing and proposed u�ilii�es • Show measurertient5 � <br /> DO NOT WRITE BELOW THIS LINE � <br /> PERMIT CONDI�IONS O <br /> 1.All calls for inspection shall be made 24 hrs.in advance-phone 259•8810. � <br /> 2.All work shall be peAormed in accordance with this permit and current City of Everett Design and Construction <br /> Standards and Specitications. <br /> ::.CaII Location Underqround Service 48 hrs.before you dig.TOLL PREE NUMBER 1-800•424•5555. � <br /> `�' �'�', `�/o����o�,s � k� � -�`• F� � <br /> � <br /> � <br /> � <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees to hold and save harm� <br /> less the City of Everett irom any and all claims tor damages, costs, <br /> `�, expenses, or causes of action that may arise because oi installation <br /> antl maintenance of the improvement or other right-of•way use hereto <br /> � appl�ed for and further agrees to remove same upon notice trom the <br /> Approved r Construction ! Date City and ro replace public properry damaged thereby. <br /> �' �� �- � . <br /> 4�L °` �"�'�y� C��-��----- c� 2 �s-��:`r <br /> FINAL INSPECTION Date <br /> ApP�oved as Constructed Signature ol Ap �ant Date <br /> everett PUBLIC WORKS DEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE STAR7ED WITHIN <br /> � 3200CedarStreet 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everett,WA98201 BE DILIGF_NTLI' PURSUED TO COMPLETION.THIS PERMIT MAY BE <br /> Phone:259�8810 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAYS DURATION. <br />