Laserfiche WebLink
—.� _ <br />�' �a <br /> r, <br /> t � <br />� �, <br /> f: � <br /> � <br /> D _.';, <br />♦F�� I I <br /> f�/'-�-. I � <br /> .• , .. .,. . . . ._ . . .. . .. . . I �i <br /> Date_��� Pu�hc Works Permit a li I <br /> r � � <br /> ApPlication For eme o�pi.+_ _ II <br /> PUBLIC WORKS PERMIT PubL�WoikSFce I <br /> To���F�� s � <br /> Less AOP� Fee PaJ S � <br /> Print or Type Only "'0incn0o` s i <br /> � <br /> �C� " S �1�r}—� • '� <br /> �wner ailing Address Gdy Zip Phone I <br /> -k--L�l���-�-1-�'� � ��J��y���h-�C1.C�(�___ 1�l.? �� `~�S?4�� <br /> �---=—�--�—=— <br /> Applicant Malling Address Gity Z�f' Phone <br /> Describe Proposed Wcrk <br /> ��v <br /> Projed Address(if known) ��/C��� I ^�� � <br /> Attach fpur(4) copies of plans tor proposed work- Draw to scale and note the following as applicable: � <br /> • ?roperty Lines • Centerline of street /w <br /> • Outline and dimensions of all exis�ing and • Indicate North ;y� <br /> proposed structures on the lot • Show any proposed �radin9 changes <br /> s Existing and proposed utilities • Show measurements � <br /> DO NOT WRITE BELOW THIS LINE <br /> PERMIT CONDITIONS � <br /> 7.All calls for inspection shall be made 24 hrs.in advance-phone 259•8810. � <br /> 2.All work shall be pedormed in accordance with Ihis permit and cunent Ciry of Everett Desi9n and Construction <br /> Standards and Specifications. <br /> 3.Call Location Underground Service 48 hrs.be(ore you dig.TOLL FREE NUMBER 1-800•424•5555. � <br /> I'?�' � �cC>fuf 2.c_[7 _ � <br /> X � , l � <br /> �i- � <br /> i � ��^ <br /> % _ � <br /> � <br /> � <br /> ACKNObVL'cDGf_MFNi OF CONDITIONS <br /> The undersiyned o�vn��r/:ipplican(hereby�grees�o hold and S�va hainr <br /> less the Ci�y of Everett Irom any and all claims for damages. costs. <br /> expenses, or causes of action thal may arise because of installahon <br /> and maintenance of the improvement or o�her nght-of-way use hereto <br /> applied fo� and further agrees to remove same unon not�!;r Iro�n thc� <br /> Approved for Construction Date City and to replace puhlic properry dama9ed thereby. <br /> FINAL INSPECTION Date <br /> Approved as Constructed Signature ol Applicant Date <br /> everett PUBLICWORKSDEPARTMENT WORK AUTHORIZED BY THIS PEFMIT MUST BF STARTED WITHIN <br /> � 3200CedarSiroet lA0 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everett.WA98201 BE DIUGENTLY PURSUED TO COP,IPI EfION. THIS PERh11T L1t�Y f�E <br /> Phone:259-8810 CANCELLED 8Y THE CITY UPON A�d'! SiOPP,1GE pp 1'✓O�+K O'J TFIIS <br /> PROJECT OVER 90 DAYS DURATION. <br />