Laserfiche WebLink
�8te � - PubLc Warks Perml�s - <br /> BIJB-Depl.N — <br /> AppliCation For <br /> PUBUC WORKS PERMIT `°°roaFaeFe $ — <br /> `�� Le53 AO�I.FB¢PaiO S <br /> ��� Balance Due $ � <br /> ��y Pnnt or Type Only <br /> 07e� <br /> Cy � <br /> t" � _ <br /> K n O ner MaJim;Adtlress Ciry� ZiP . �Phone <br /> 'Jtl <br /> �N� - ,i �r -. . t � � . �-C r -J� , c . . <br /> ��� � y 1APPIicant �Maihn�Address City . Zip �Phone I <br /> { <br /> HC � <br /> Describe Proposed Work + <br /> ��g _ <br /> o. � i, <br /> �y� - - W ! <br /> ..y 1 <br /> �H ' Project Address(if known) . i' �'' � �� � <br /> ��� . `-�.�. . '� . <br /> r .lttach four(4)copi's o�Plans tor proposed work- Draw to scale and note the following as applicable: � <br /> ��� . • Prooerty Lines • Centerline of street � , <br /> � • Outline and dimensions o'all existing and • Indicate North I <br /> proposetl sVuctures on the loi • Show any proposed grading changes <br /> � • Existing and ProPosed uhlities • Show measurements M � <br /> DU NO7 WRITE BELOW THIS LINE O <br /> c PERMITCONDITIONS <br /> I �� 1. All calls for inspection shall be matle 24 hrs.in advance� phone'1S9•SH7 5. � � <br /> 2. All work shall be performed in accordance with this permit antl wrrent City of Everett Design and Construction <br /> Standards antl Specifications. <br /> � 3. Call Location Underground Service 48 hrs. before you dig.TOLL FREE NUMBER 1•800-424-5555. � , <br /> i <br /> , �� ` f �L"y ' . ._. � - . . _" � � <br /> i <br /> � �; � <br /> O ' <br /> __ a <br /> ; <br /> , <br /> I �U, ACKNOWLEDGEMEN70FCONDITIONS <br /> \ � <br /> \ The undersigned owner/applicant hereby agrees to hold and save harm� <br /> � less the Ciry of Everett from any and all claims for tlameges, costs�, <br /> � _. _ . expenses. or causes of action that may arise because of installation <br /> ' /'�� � . � �s�� � -�� antl maintenance of the improvement or other right-of-way use hereto <br /> ' .� � _ r� �'-� applied tor antl furiher agrees to remove same upon notice from the <br /> �' Approved for Construction - �Date City and tn replace public properry damaged t�ereGy. <br /> ' FINALINSPECTION �a�e� � Date <br /> Appioved as Constructed S�gnature of Applicant <br /> WORK AUTHORIZED BV THIS PERMIT MUST BE. STAFTFD WITHIN <br /> �. everett PUBLIC WORKS DEpARTMENT 180 DAYS OF DATE PERMIP IS ISSUED AND THEREAFTER IS TO <br /> � 3200 Cedar Street BE DILIGENTLY PURSUED TO COMPLETIOM.THIS PERMIT MAY BE <br /> Everett,WA 98201 CANCELLED BV THF GTV UPON ANV STOPPAGE OF WOF7K ON THIS <br /> Phone�. 259-8815 pqOJECT OVER 90 DAYS DURATION. <br />