Laserfiche WebLink
Date �Z�z��93 <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Qnly <br />Mailing Address <br />c��y <br />Pue!¢ WaAa PerMl . ✓✓ � <br />e�aa oeo�- • �— <br />Pooi¢ Works Fee s <br />Tote� Fee <br />Lesa Ap01 Fee PeiC 5 / <br />Oelenca �ue s � �" �� <br />00z- .j�'Z'!O / 7r3>'/ <br />Envirornental Science & Engineering Inc 15444 DE 95th St. //244 Redrub 98052 869-8220 <br />Applicant Mailiug Address City Zip Phone <br />DescribeProposed Wo�k Drill, install, and periodically sample one two-inch inside diameter ground- <br />water monitoring well in the turning lane of N. Broadway Avenue at �28 N. Broadway. Well to <br />be olaced to avoid utilities as marked by U.L.S. Approximate location and traffic plan r' <br />shown on attached Fiaure 2. <br />Project Address �i� knownl 928 N <br />Attach four (4) copies of plans for proposed work - Oraw lo ccale and note Ihe lollowing as applicable: <br />• Properry Lines � CeMerline ol street <br />• Outline and dimensions of all existing and • Indicate North <br />proposed structures on ihe lot • Show any proposed grading changes <br />• Existing and proposed utilities • Show measurements <br />tor <br />PERMIT CONDITIONS <br />1. All ca116 for inapection shall be made 24 hrs. in advance • phone 259•8810. <br />2. All work ahell be pertormed in accordance with this permit and current City of Everetl Design and Consiruction <br />Standerde end Spedficalions. <br />3. Call Location Underqround Service 4B hrs. before you dig. TOLL FREE NUMBER 1•800•424•S5S5. <br />z e�-n-c.z-�-++� � -�;`� <br />Date <br />e_��--C— __ 5 /�- 9�f <br />FINAL INSPECTION Date <br />Approved as Constructed <br />�PUF3LIC WORKS DFPARTMENT <br />3200 Cedar Sveet <br />Everett, WA 98201 <br />Phone:259�88�0 <br />ACKNOWLGDGEMEN? OF CONDITIONS <br />W <br />� <br />� <br />� <br />� <br />O <br />� <br />� <br />O <br />a <br />The undersigned owner/applicant hereby agrees to hold and save harm� <br />�ess the Cily ol Everett lrom any and all claims to� damages. rosts. <br />ex enses, or causes of acfion �hat may arise because of installation <br />la� �iaiNenance ol the impro�ement or other righbobway use hereto <br />applied �or and Iwther agrees lo remove same upon notice Irom ih= <br />City and to replace pubhc property damaged thereby. / <br />/ <br />i 3-q�F <br />Signa�ure ol Applica Da�e <br />WORK AUTHORIZE 8Y THIS PERMIT MUST BE STARTED WITHIN <br />18G DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERiv11T MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WOAK ON THIS <br />PROJECT OVER 90 DA1'S DURATION. <br />