Laserfiche WebLink
Date I 0 0 Public Work@ Permit a ej� /3 <br />IAppl Thor `.)i Oldy Dept <br />PUBLIC WORKS PERMIT ��770, Public Works Fee <br />Total Fee • lJ <br />Lau spirt Fee Paid • <br />\r Due • <br />Print or,Sype Only — <br />Owner \ Mailing Address City Zip Phone <br />Ave 62ie <br />Apphcanf Mailing Address <br />�.-�/J/�!� City Zip Phone <br />Describe Proposed Work -d.EI Vi —5---="-- = — <br />Prolec.t Address lif anownl <br />Attach four (4) copies of plans for proposed ,crk • Draw to scale and note the following as applicable: <br />• Property Lines • Centerline of street <br />• Outline and dimensions of all ex sting and • Indicate North <br />proposed structures on the lot • Show any proposed grading changes <br />• Existing PnJ 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 259.8810. <br />2. All work shall be performed in accordance with this permit and current City or Everett Design and Construction <br />Standards and Specifications. <br />3. Call Location Underground <br />_Service 48 hrs. before you dig. TOLL <br />LFFREE NUMBER 1.800.r42(4.55.•cr r. z <br />y PCf/Yeti d <br />p r u z � 06�<c u��s otf <br />'5rC7K\A10R!C a<lip 0 ��ero,'/ZZ �8 <br />on <br />App� r ,On 1 ucI ion ��f�aDj-attee <br />INAL INS ECTI Dr ate <br />Approved as Constructed <br />evrrett PUBLIC WORKS DEPARTMENT <br />Ever tt, WA Street <br />Everett. WA 98201 <br />Phone. 259-8810 <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 />expenses, or causes of action that may arise because of installation <br />and maintenance of the improvement or other right-of-way use hereto <br />applied for and further agrees to remove some upon notice from the <br />City and to replace public property damaged thereby. <br />0% a/ &5 -g8 <br />irri"Signature of Applicant Date <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />130 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />