Laserfiche WebLink
Date �°�'���3 <br />ppplication For <br />PUh3LIC WORICS P�RI�IIIT <br />Print or Type Oniy <br />� ` -I <br />, �l �'t > <br />< j� . � t. r „� ;/ /ii/I � i <br />Address <br />Pu�llc Works Pcrml� » � �f+� � <br />Bldg. Dept � , / 4 <br />Publlc Works Pea 5 --�r� � � <br />Toi�l Fee <br />LescA001. Feo Paid $ �-- <br />9aiance Ouo S �' � � <br />;/ �%,!���/ ci%' <br />C i: t ,: r � <br />Zip Phone <br />�.`�l i 1 ii C`� Phone <br />Applicant <br />Mailing Address ���Y Z�P <br />//�,''.i i). �. <br />Describe Proposed Work <br />� ��, � ;�. � i -'[ ; C � l ��t L � . , i i � i <br />Project Address (if known) <br />Li'1 /i' I'�F;�fiCr.�.�,' t�_�5'yjr ��.' ldlio /� c_Y� ,� <br />Attach tour (4) copies of plans br pr000sed work - Draw to scale an� note the following as applicable: <br />• Centerline of street <br />• Property Lines • IndicatP North <br />• Outl�ne and dimensions o( all existing and � Show any Nroposed grading changes <br />proposed structures on the lot O Srnw measurements <br />• Existing and proposed ulilities <br />PERMIT CONCITIONS <br />7. All calls for inspection shall be made 24 hrs. in advance - phone 259•881 S. <br />2. All work shall be oerformed in accordance with this permit and current City of : verett Design and Construction <br />Standards and Sr�cifications. <br />3. Call Location Un�erground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800-424-5555. <br />,/ ' � b t <br />!C ,�ree.,. - bC�� ��St me� eGre.ti l� yao� <br />/ ' <br />c�e.uu.�� . <br />� ���� ���� �« <br />1 �\.��.1 <br />� <br />. <br />Approved as Constructed -� <br />everett PU6LIC WORKS DEPARTME <br />� 3200 Cedar Sireet <br />Everett, WA 98201 <br />Phone 259-8815 <br />„ ..1.� c �oy� l� � � r <br />lc� <!'.�cK4, <br />1 <br />1'J� <br />Date <br />���K�•�� � <br />ACKNOWLE�GEMEMT OF CONDITIONS <br />The undersigne�i owner/applicant hereby agrees to hold and saae harm� <br />!ess the City c`. Everett from any and all daims tor damages, costs, <br />expi�nses, or causes of action lhat may arise because of installation <br />anG maintenance of the improvemenl or olher right-ol-way use herelo <br />applied for and iurther agrees to remove same upon notice irom the <br />City ana` o replace pu Y% properry damaged thereby. <br />/ � <br />���� ��T-`� �- -�. .: <br />�� ,�,- � , <br />� ' Date <br />Sigr�ature ot-Applicant <br />WORK AU��HORIZED BY T!�IS PERMIT MUST EE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY' PURSUED TO CrJMPLETION. THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON AIJY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATIOFJ. <br />