Laserfiche WebLink
Date��� <br />Applicetion For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />Applicenl <br />Ueacri6e Praposed Wark <br />Projecl Address 111 knownl <br />7`k <br />cnv <br />v„ni.c wo�xe rn,mn . �y /���� �� <br />Piay Oepl � .�(/_%/ " _ <br />voeec worta ree <br />Tmellen f _ <br />Lrsalnpl f�ePAi� !S <br />f]qlq��P nuP i <br />98av� as��ii� <br />7i� phone <br />Malhng AAdress City Zip Phune <br />Attech fow (4) copies ol plena lor proposed work - Draw to scale and note Ihe lollowing as applicable�. <br />• Property Line3 <br />• Oulline and dimensions af all existing and <br />proposed structures on the lot <br />• EMIsling anC proposed utllities <br />• CenlerlinP ol slreet <br />• Inditete Nor�h <br />• Show eny proposed grntling Chenges <br />• Show measuremenrs <br />PERMIT CONDITIONS <br />i. All celis lor Inepectlon shell ba meda 24 hrs. In edvence • phone 259•8810. <br />2. Ali work ctall be pedormed In accordence wlth this permlt end currenl City oi Everett Design end Constructian <br />Stenderda end Specllicatione. <br />3. Cell Locallon Underpround Servlce 48 hre. before you dig. TOLL FREE NUMBER 1•800•424•5555. <br />Approved for Construclion <br />�v3�i� l.�[wce4 �� �- 1`��r � <br />�'(/z/�ju <br />-�,�„c �n`�— <br />ACKNOWLEDGEh'ENT OF CONOITIONS <br />W <br />H <br />� <br />� <br />O <br />� <br />� <br />O <br />a <br />The underslgned owne�/epplicanl hereby egrees to hold and Bnve herm- <br />less Ihe Gly ol Everell Irom any end all claims for dameges, costs. <br />evpenses. or c�uses ol action tnat may erlse because ol inslallalion <br />and maintennnce ol Ihe improvement or other nghbol�wey use herelo <br />epphed lor and lurthrr a�rees to �emove seme upon nolice ��om Ihe <br />Cily anA lo replar,e puUlic propertY damageA ihereby. <br />FINAL INSPEGiION Dote <br />Approved 86 Con9lructed Siyna�urc ol ApPhcant Date <br />everelt PUPLIC WORKS DEPARTMENT WORK AUTI10fiIZED 9Y 1HIS PERMIT MUS7 13E STARIED WITHIN <br />tB0 DAYS OF DATE PERMIT IS ISSUEO AND THEREAFTER IS TO <br />� 3200CederStreet BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAV BE <br />Eveiett, WA 98201 CANCELLED BV -fHE CITV UPON ANY STOPPAGE OF WORN ON TH�S <br />Phene. 259�Bn�0 PROJECT OVER 90 DAVS DURATION <br />