Laserfiche WebLink
_ ___�__._,r-. _ � .�., <br /> �8�e_�`� PUEIie WorMa Parmlt• �� 60 <br /> Application For eia9.oeou � Q <br /> PUBLIC WORKS PERMIT Pu0licWarkaFee <br /> Total Fee j <br /> Lene Appl Feo PaiC a� <br /> PrintarTyneOnly e.�,��ao�. s�3Co73— <br /> �69js <br /> � � �����-�r ;h�� �.�v.d�/I 9�.zo� 07�7-�» <br /> lJwner Mailing Address City Zip Phone <br /> Applica� Mailing Address Ciry Zip Phor.e <br /> )�/ <br /> Describe Proposed Work �Z ��`A/T /��� <br /> � �---�1�''¢ -�-, <br /> Prolect Address(if known) � , ��rl�f 1 � � <br /> Attech four(A) copies of p�ans for p:oposed work- Draw to scale and note the following as applicable: � <br /> • Property Lines A Centerline ol^,treet � <br /> • Outline and dimensions of all existing and � Indicate North <br /> proposed structures on the lot 1 Show any proposed grading changes <br /> • Existing and proposed utilities • Show measurements � <br /> DO NOT WRITE BELOIN THIS LINE O <br /> PERMIT CONDITIONS <br /> 1. All calls for inspection shall be made 24 hrs. in advance-phone 259-8815. �� <br /> 2. All worM,shall be performed in accordance with this permit and current City ol Everetl Design and Conslruction <br /> Standards and Spacifications. <br /> 3. Cal�Location Undergruund Sarvice 4B hrs.before you die.TOLL FREE NU67BER 1-800•424•5555. � <br />! �: �.�-�- ����-��/`��`�-. O <br /> I-- <br /> � i <br /> O <br /> a <br /> ACKNOWLEDucR4ENT OF r,ONDITIONS <br /> The undersigned owner/applicant hereL�;�agrees to hold and save harm� <br /> � less the City of Everett irom nny and all claims for demages, costs, <br /> expenses, or causes of action that may arise because of installation <br /> � and mainlenance of Ihe improvement or cther righhof-way use hereto <br /> ' applied for and further agrees to remove same upon notice irom the <br /> App ved fo Conslri•ction Date I r,ity and to replace public property damaged thereby. <br /> " l,l ��� (� � � <br /> FlNAL INS CTION Date � <br /> Approved as ConsVucted Signature of Applicant ' � <br /> everett PUBLIC WORKS DEPARTMENT b'JORK AUTHOFlIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> � 3200 Cedar Street 180 DAYS OF DATE PERMIT IS ISS:IED AI�� THEFEAFTER IS TO <br /> Eve:ett WA 5d201 BE DIUGENTLY PURSUED TO COMPLETION. TFi1S PERMIT MAY BE <br /> Phone: 259-8815 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAYS DURA710N. <br />