Laserfiche WebLink
Date�Ll�=�1 <br />Application Forp <br />PUBLIC W�RK�PERMIT <br />Q <br />O <br />O <br />O <br />Print or Type Only <br />�=�iLUu-G�c- <br />Owner <br />_ J!] /l��'./ <br />Hpplicant <br />� O O O <br />� <br />r� a o� m <br />ca .-. .� r� <br />ai ,-� .�+ <br />.+ w w <br />_.�__ <br />Mailing <br />Mailing Address <br />1 <br />Pubi�c L'/orFs Pnrmil • ��L / _f--- <br />�inq Deui.. _���Z���--.. <br />Puohc Wons Fee S /.7R�7 <br />Totrl Fee �� �� � <br />less Ap01 Fee Pam $- 7_ <br />i � <br />EaWnr.e�ue $_ ._ <br />Zip Fhone <br />City Zip Phone <br />Descr�be Proposed Worh �!�'il I n tll'1 �/1 � u/`U/(LS'/— //(/l/� � _ <br />Projecl Address lil knownl <br />Adach lour'41 copies ol plans for proposed work - Uraw Io scale and note the foliowing as applicable: <br />• Property Lines <br />• Outline and dimensions of all existing and <br />proposed structures on Ihe lol <br />• Exisimg and proposed utillties <br />• Centerline o( street <br />• Indicate Norih <br />• Show any proposed gr�diny changes <br />• Show measurements <br />PERMIT CONDITIONS <br />t. All calls for inspection shall be made 24 hrs. in advance- phone 259•8810. <br />2. All work shall be pertormed in accordance wilh ihis permit and wrrent City of Everett Design and Construction <br />Stan.tards and Specilications. <br />3. Call Location llnderground Service 48 hrs. betore you dig. TOLL FREE NUMBER'1-800•424•5555. <br />�i. /�-�r ��i��c,��.u!,s d���-� �"/�4-8% <br />FINAL INSP <br />Approved as <br />evereu <br />� <br />PUBLIC WORKS DEPARTMENT <br />3200 Cedar Street <br />Everett, WA 9d20t <br />Phone: 253�8810 <br />�, r- <br />Date <br />ACKNOWLEDGEMENT OF CONDITIONS <br />W <br />H <br />� <br />� <br />� <br />� <br />� <br />� <br />a <br />fhe undersigned owner/applicant hereby agrees to hold and save harm� <br />less the City of Everetl Irom any and all claims lor damages, cosis, <br />eapenses, or causes of action that may arise because ol installation <br />and maintenance ol the improvement or olher right-ol�way use hereto <br />applied for and turlher agrees to remove same upon noHce I�om the <br />Cily and to replace F�ublic property damaged thereby. <br />�•, ��., _ � �� � <br />Signature ol Applican Date <br />WORK AUTHORIZED BY THIS �ERMIT MUST BE STAfiTED WITHIN <br />180 DAY5 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 />