Laserfiche WebLink
Date�.�1—f2'-�^��� <br />Application For <br />�PIIBLIC WORKS 6�ERMIT <br />Print or Type Only <br />c�.l(, �iL'.(Gti�cJ�/� <br />%/�' -' <br />c��� � <br />Pu���c Worke Pe�mn r _y—�--- <br />BIdO� JepL • <br />PuGlitWorktFev 5 �+�� /7�) <br />To�al Foe <br />Less AOP�� Foe Paid S <br />Be�anco Duo § <br />% 0!S7 <br />i/Cc� !b�%l / �( r r'� ;y� 'i'./ic-,.� ;<��� :/V �:- <br />Ciry Zip Phone <br />�l[L�/�(./G Zi �hone <br />Applicant <br />Mailing Address City P <br />/�, i�/ll� J � ��%ix� �� "�%''c �z %>i��orl��fl� -- <br />Dascribe Proposed Work / <br />-7 � r/ <br />ProjectAddress�itknown) _L�l'��� — <br />h t II in as applicable� <br />AttaCh four (4) copies ot plans lor Proposed woik - Diaw to scale and nole0 Centerline of straet <br />) Property Lines • Indicale North <br />� Outline and dimensions ol all existing znd O Show any proposed grading changes <br />proposed structures on the lot O�,how measurements <br />s Existing and proposed utilities <br />L <br />PERMIT CONDITIONS <br />1. All calls for inspection shall be made 24 hrs. in advance - phone 259�881 5. <br />2. All work shall be pertorme� in accordance with ihis permd ana current Ciry ol Evorett Design and Construction <br />Slandards and Specitications. <br />3. C&II Location Underground Service 48 hrs. belor�� you dig. TOLL FREE NUMBER 1-500•42�i•5555. <br />i.../� ��' _',/'' <br />�d �orr onsiruction ' <br />FINAi INSPECTION �/ <br />Appro�ed as Conslructed \ � <br />everett PIIBLIC WORKS DEPARTMENT <br />� 3200 Cedar Sireet <br />EverelL 6NA 98201 <br />Phone:259-G615 <br />ACKNOWLEDGEMENT G- COIJDITIOPIS <br />The undersigned owner/applicant hereby agrees to hold and save harrt�- <br />—' less the City of Everetl from any and all claims lor damages costs. <br />expenses, or causes of aclion that may arise because oi mstallation <br />�7�and maintenance of the improvemeM or other righbol-way usc hereto <br />• applied for and luriher ogrees te remwe same upon notice Irom the <br />Date Cily-and�o replace public�(iroperry damaged thereby. <br />d � i ��� ` -�� ��_ � --�� �`/ <br />Date Date <br />�Sig iw�e oi �pplicnnt <br />K AU�HORI2ED BY THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT 13 ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO GOM�LETION. THIS P[R�.11T f.tAY BE <br />CANCELLE-D B'f TNF CITY UPON AtJ1' STOPPAGE OF VJORIS ON T� �Ir� <br />PROJFCT OV[R 50 Di�YS DURF�TION. <br />IC: <br />