Laserfiche WebLink
r <br /> ' a <br /> � �; <br /> � � <br /> I ; -� <br /> � <br /> ' �`� <br /> :�.� <br /> i '' R <br /> i ; •'� <br /> � <br /> Date�Cu�� PupLc Works Pcrmil• I : <br /> ! ( �1 � <br /> Application For e1ao.o�ni.» ���„z(�L� � ''�"`�� <br /> i <br /> PIJBLiC WOEiKS PERIVIIT v��b;o;;F��`°` � -- ;: ; ; <br /> lessAnpl FeaPala S _ � <br /> Balanu�Due S '� � <br /> Print or Type Only - <br /> I <br /> C�� �, /S .7,� � /(f)on /h,Jl Crpn�. ✓�lv /yliJ/C�nN,� Gc�P/a I <br /> Ownel Mailing Addre,s City Zip Phone <br /> Sa mti 7 �S -D�.2 <br /> Applicant Mailing Address City Zip Phone <br /> Describe Propcsed Work a/�i{r� l��Y(��' �� !�� /I(��� ��'vl f� ( I /' /'ry/1,'�y���� � <br /> Project Address(i( known) �/_�� — ��7 �y Pu b/ �� � <br /> Attach lour(4) copies of plans for proposed work- Draw�o scale anA note ihe �ollowing as applicable: � <br /> i Pronerry Lines • Centerline of sheet � <br /> • Outline and dimensions of all existing and • Indicate North �� <br /> proposed structures on ihe lot • Show any Propoc�d c�rading changes <br /> • Existing and proposed utilities • Sl�ow measureir��„�s <br /> DO NOT Wf71TE BELOW THIS LINE � <br /> PERMIT CQNDITIO17S � <br /> t.All calls(or inspection shall he made 24 hrs.in advance- phone 259•8810. � <br /> 2.Ali work shall be performed in accordance with this permit and current City of Everetl Design and Construclion <br /> Standards and Specifications. <br /> 3.Call Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1-800•424•5555. q <br /> G <br /> iJ � ; O <br /> ����;�<� , ,� ,�_��:� < �� %����.,: �,��,�, ���� ,� �� �;. <br /> �/ /� � <br /> ���� �;�.;�%�� d/♦ <br /> � <br /> � <br /> � <br /> ACFNOWLEDGE�IGNT OP COND�TIONS <br /> Thc undersiyned owner/applicant hereby a9rer,s to hold and save harm� <br /> - loss ihe City of Everett Irom any and all claims for damages. costs. <br /> expenses, or causes ol action ihat may arise because ol installation <br /> and maintenance of ihe improvement or oth^r right-of-way use hereto <br /> applied for 2nd lurther agrees �o remove same upon notice from Ihe . <br /> Approved for Construction Date City and to replace public property damaged thereby. <br /> FINAL INSPECTION Date I <br /> Approved as Construded Signa�we ol Applicant Date � <br /> everett PUBLICWORKSCEPAPTMENT WORK FlUTHORIZED BY THIS P[RMIT MUST BE STARTED WITHIN <br /> � 32ooCedarStreet 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everett,WA 98201 BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY B[ <br /> Phone:259�8810 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WOflK ON fHIS <br /> IPROJEGT OVER 90 DAYS DUR.4TION. <br />