Laserfiche WebLink
Date��_�-���� � <br /> P'.ALr Wnile Pnrmr�• <br /> ApPhta�ion For emu Oeo� . � � <br /> PUBLIC WORKS PERMIT Puhtot�feeFee s — <br /> Leae ApPI.Pee PeiE s <br /> Print or Type Only e.�w�,sn�� s <br /> ��1C?�]C1a�=� `�i► II►I �l ��l�h� ►!l'1��' �;i ��, � � ;�) -'��/ �iC1lr� �� > <br /> �W0A/ Mailing Add�ess lri � <br /> C�ty LP Phone <br /> ; .Y I� ��Y <br /> Applicant Mailing Atldress <br /> y�,� C�ry 2ip Phone <br /> Descri6e Proposed Work �"L./��/ // y� � / <br /> �� %� <br /> _ �� <br /> Pro�ect Addrese(il known) W <br /> Attach lour(4)coplea of plans lor proposod work- Dra�v to scale and note the lollowing es npplicable: � <br /> • Properry Lines — <br /> • Oulline antl dimansions of ell exisling and � Cente�line of slrer� � <br /> proposed st�uctures on the lol � ��dicete North <br /> • Exisling gnd proposed utllities � Show any p�oposed greding changes <br /> • Show measuramanfs <br /> DO NOT WRITE BELOW THIS LINE � <br /> PERMIT CONDITIONS O <br /> 1. All calls fo�inapectlon shall be made 24 hr,. In advance- phone Z$Q•88�$, <br /> 2. All work eholl be pe�formed In accordanr,e with this permit and current City of Everelt Design and Construction ' <br /> Slandards end Specllicalions. <br /> 3. Cell Locetion Unde�pround Service 4p hra. before you dig.TOLL FREE NUMBER 1•8�0•424-5555. <br /> �U(�vc � <br /> L*-�ae,�s ,��,,�,�i,��T �t/oT O <br /> � �F'�c.e�',o fL�-s 7 <br /> ��� <br /> � <br /> � <br /> 0 <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owneqappGcant hereby egrees to hold and save harm- <br /> less tha Clty of Evarett irom any end all clalms br damages, costs, <br /> expenses, or ceuses ol ecfion that may arise hecause o1 installalion <br /> and mainlenunce ol Ihe Improvament or other righbobway use hereto <br /> i Approved lor Consiructlon Dale applied for and lurther agrees fo remove same upon notice Irom ihe <br />� City and lo replace public rnope�ry Aamaged thereby. <br /> FINAL INSPECTION <br />. Approved es Consiructed Date <br /> Signnture ol Applicant Dale <br /> rvPrett PUBLIC WORKS DEPARTMENT WORK AUTHORIZED BV THIS PERIAIT hIUST BE STARTED WITHIN <br />� � 3200 Cetlar SVeet 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTEP IS 10 <br /> Everett, Wq g8201 BE DILIGENiLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Phone:259�8815 CANCELLED BV THE CI7V UPON ANY STOPPAGE OF WORK ON 7HIS <br /> PROJECT OVER 90 DAYS DURATION <br /> � � <br />