Laserfiche WebLink
Date�l <br /> r��n�.�wo�ws rQ.�mn—.7�/ tr r� <br /> AppliCetion For Biaa oen� •y2�l�/ <br /> PUBLIC VNORKS PERMIT PummWo�keiee � - - <br /> Lolel Fee 5 <br /> ieaeenni FeePai� S <br /> Print or Type Only Belmre0ue 6 <br /> ���=��y�tl�{AI �,� ly�/l�'J,�'�' �l� #�����'lJ�� �7'�//9 <br /> r.� <br /> oW�e� T,�ailingAddress City Zip Phone <br /> �.'C,y114 <br /> Applicenf Mailing Address City Zip Phone <br /> Describe Propoaed WorX c�t.iii��//�Cv1�/�.i��/� <br /> , W <br /> Pro�ect Add�ess pl known� �� � � <br /> Attach lour(4) coples ol Dlans lor proposad work- Draw lo scele and notr. the lollowing as epplicable: � <br /> • Property Linea • Centerline o�streal � <br /> • Ou�line and dimanalons of all eMisting entl • Indicate Norih <br /> proposed siructuras on the lol • Show any proposed yrading chenges <br /> • Existing and proposed ulilitias • Show measuremenis � <br /> DO NOT WRITE BELOW THIS LINE <br /> PERMIT CONDITIONS � <br /> 1. All cells lor Inapectlon ehell be mede 24 hrs. in odvance� phone ZS9•$8�rj. � <br /> 2. All work ehell be per�amed in accordance with Ihis permit end currenl Cily of Fverelt Dnsign and Conslruction <br /> Stenderds end Specificetions. <br /> 3. Cell Locetion Undarground Servica 48 hrs.belore you dig. TOLL FpEE NUMBE.R 1-800•424•5555. � <br /> Ti_s,p�,��ir�rT /s NoT ,t�F_�, �.;�'�,� • % O <br /> ��; <br /> 9•S-y� � <br /> � <br /> O <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIUNS <br /> The undarsigned owner/applicent hereby agrees lo hold and aeve herm- <br /> — less the City ol Eve�etl Irom eny entl ell claims mr demages, cosls, <br /> e�penses. or ceuses of ection that mey erise necause of installation <br /> and meinlenence of ihe improvement or other riqht-ol-way� use hereto <br /> App�oved lor Gonstrucllon pa1e epplied lor and furiher egraes to remove seme upon not�ce Iwm Ihe <br /> City end lo replace public proper�y damaged thereby. <br /> FINAL INSPECTION Dale <br /> Approved es Construr,ted Signature ol Applicenl C�xte <br /> vve•rrit PUBLIC WORKS DEPARTMENT WORK AUTHORIZED BV THIS PERMIT MUST BE STARTED WITHIN <br /> � 3200Cedar5lreet 1B0 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTEP IS TO <br /> Evere�t.WA 98201 BE DILIGENTLV PURSUED TO COMPLETIOI.I. THIS PERMR MAV BE <br /> Phone� 259-8815 CANCELLED BV THE CITV UPON ANV STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAYS DURATION <br />