Laserfiche WebLink
4���T�r __ 1 . �..� ..lr^,.N. _. <br /> _ , . . . . _ ' . r <br /> ._ � ...., .. . .. <br /> . 5Q„��,�= �iu:.,z: .��,, <br /> Date�_ np //� �.�s-a9 � �-?_3/ <br /> l Publit Works Permil R <br /> Application For � eiaq.oep�.x <br /> PUBLIC WORKS PERMIT PubTolaFeeFee 5 <br /> � Less ApO�Fea PaIC � <br /> --� ,� <br /> Print or Type Only ..; t°? , ea�a�<eo�a s �� — _ <br /> f <br /> . 1 <br /> !.��i11i�'L�r��'� ����r� �'��,���Ll ��(���Ig-, <br /> Owner Mailing Address ., � � Ciry Zip Phone <br /> S�Yl.�l1t�- ` . <br /> Applicant Mailing Address � Ciry Zip Phone <br /> Describe Proposed Work IlI�����n_����/"'����� ( �l1 '� <br /> W <br /> Project Address(if known) � <br /> Attach four(4)copies of plans(or proposed work-Oraw lo scale and note the following as applicable: � <br /> • Property Lines • Carierline of street � <br /> • Outline and dimensions of all existing and • Indlc�te North <br /> proposed structures on the lot • Show any proposed grading changes <br /> • Existing and proposed utilities • Show measurements � <br /> DO NOT WRITE BELOW THIS LINE O <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 performed in accordance with this permit and current City of Everett Design and Construction <br /> Standards and Specifications <br /> 3. Call Lucation Underground Service 48 hrs. before you dig.TOLL FREE NUMBEfl 1•800•424-5555. � <br /> ��/� P�,ei�iTS Lt/iLL BE� /SSVCv ll�t/TiG �fISEi�E.c%� O <br /> ����U�Lc,✓T �S SiG.u��j �t/OTai'izEO 9.�/� l�ct/�E.�ED <br /> Tn Tiff Ci� Of ��E2E7J: � <br /> V♦ <br /> 1'y { O <br /> },, : a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees to hold and save harm• <br /> less the City of Everett from any and all claims for damages, costs, <br /> <=���, � . .�o� expenses, or causes ot action lhat may arise because of installation <br /> � �� 7 fY/�7 and maintenance of the improvement or other right-ol-way use hereto <br /> '��lr� app�ied lor and furlher agrees to remove same upon notice from the <br /> Approved for nstruct on Date City and to replace public prope(ty da aged thereby. <br /> G ' ll / (/ C/ <br /> pf C \ / <br /> FINAL 1 SPG TION Dale C� ���`-..`�.�. �.� ,_ � �^- �/ �' :( •- � c� ..� �..� <br /> Approved as Constructed Signature of Applicant Date <br /> everett PUBLIC WOFKS DEPARTMENT �✓ORK AUTHORIZED DY THIS PERMIT MUST BE STARTED WITHIN <br /> � 3200CedarStreet 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everett,WA 98201 BE DILIGENTLY PURSUED TO COMPLETION.THIS PERMI7 MAY BE <br /> Phone: 259•8815 CANCELLED BYTHE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAYS DURATION. <br />