Laserfiche WebLink
Date� �"/�� <br />/ <br />qppiication For <br />Pl1�Li� WURKS PERIUIlT <br />Print ur Tyue Only <br />$�l I��� <br />Puhl'ic Yloiks Pe��� � � � �5 <br />Bitl9. Dt��. a __ <br />Pu�l'm Works Fee 5 �(j •� <br />Totnl Fee � — <br />Loss ApP�� Feo Paitl S�� —� <br />r��dancoouo S �O ��—.- <br />- .—. 69��'��' <br />Phone <br />Mailin9 Adure�` <br />— — City <br />AGP.ia i i/ <br />„ris,�y-c ��`G!/i�DElf'bt,t'�'�=T� ,�ic=tcN, — <br />Describe Proposed WorY. � _ _ <br />Project Address (if known) _ <br />� �-i o <br />1 <br />�� l_n�. <br />AltacF. tour (4) copies ot plans tor proposed work - Draw to scele and nole lhe �ollowin9 as applicable: <br />t <br />• Properry Lin^s <br />• Outline ond dimensions ot all existing and <br />propasc � structures on the lot <br />• Existing ard proposed util!�ies <br />CT_ <br />O Centerline o( stree <br />• Indicate North �ading chan9es <br />• Shuw any proposed g <br />• Show measuremeNs <br />PERMIT CONDITIONS <br />1. All calls lor inspection shall be made 24 hrs. in advance - phone 259•88 <br />2. All �••orl: shall be performeo in eccordance with this permit and current City of Everett Design and Gonstruclion <br />Standa:ds and Specifications. <br />3. Call Location Underground Service 48 hrs. beforo you dig. TOLL FREt NUMBER 1-800�424-555 . <br />-�-_> � ,_i.` ��_� s�� r- �y <br />� Date <br />pproved n/to�r Construclion <br />� �Date • <br />F�NAL� N <br />Approved as C� .structed <br />everett PUBLIC WORKS DEP.�IRTMENT <br />� 3200 Cedar Siree! <br />Evere!t. WA 98201 <br />Phone: 259-86� 5 <br />� <br />�' <br />.:; <br />�' <br />i�CKNOWLEDG[MENT OF GO�JUITIONS <br />7�ie undersi9ned o�vner/applicznt nereby a9rees to hold and save harm- <br />less the City of Everett from any and all claims for damages, costs, <br />ezpenses. or causes ot action thal may arise because of 5eahereto <br />and mainlenance ot lhe improvement or other righPof-way <br />applied for and further agrees to remove same upon notice from the <br />City and t, reFlace public property damaged thereby. <br />Date <br />SignaWre <br />7JBORDAYS OFPDAT�E PERMIT SEISSUED ANDBT 1EREAFT�ER ISH�O <br />GANCEGLED OY THE C TYDUPONOANY STG.'PAGE'OF WORK ON THBIS <br />pROJEGT O'JER 90 DAYS DURATION. <br />4 <br />r <br />H � <br />cn — <br />� t <br />r: <br />C7 � <br />C � <br />� <br />�� I <br />-: �. <br />C�? <br />F <br />!� :' <br />r <br />�y ;- <br />`� � <br />� <br />Q� <br />r, <br />,� � <br />� <br />� �.' <br />