Laserfiche WebLink
Uate �� - � I <br />Application For <br />Pl1BLIC WORKS PER9VIiT <br />Print or Type Only <br />Pubbc Works Permlt `{� <br />G�` I It-1"/•�lT <br />Bltlp. DepL • C7 I t�s� <br />Publlc Works Fce S —. <br />Totul Fee <br />Less ApPI. Fee PniE S---�- <br />6alanco Ouo � <br />�YY�.��... <br />Jescri6e Proposed Work <br />Project Address (if knownl `� � / <br />Attach lour (4) copies ol plans for proposed work- Draw to scale and note the tollowing as 'FP��cable: <br />• Property Lines <br />• Oulline �nd dimensions of all existing and <br />proposed structures on the lot <br />• Existing and proposad idilities <br />• Centerline of street <br />• Indicate North <br />• Show any proposed grading chanc�es <br />• Show measurements <br />PERMIT CONUITIONS <br />1. All cal�s for inspection shall he made 24 hrs In sdvance - phone 259•8816• <br />2. All work shall be performed in accordance with this permit and currenl City oi Everetl Design and Construction <br />Standards and Speci!ications. <br />3. Call Location Underground Service •AB hrs. before you dig. 70LL FREE NUMBER 1•800•424-555 . <br />, �Z- S� 8 � <br />cvp`t— �R�.c�� � 2.� L�� <br />Approved for <br />Date <br />FINAL INSPECTION Date <br />Approved as Construcled <br />everett PUBLIC WORKS DEPARTMENT <br />� 3200 Cedar Street <br />Everett, WA 98201 <br />Phone: 259�837 5 <br />� <br />V <br />AGKNOWLEDGEME'+T OF CONDITIONS <br />The undersigned ownedapplicant hereby agrees to hold and save harm- <br />le�s the City of Everelt from any and all claims for damages, costs, <br />exoenses, or causes of aclion lhal may arise because of installation <br />and maintenance ot the improvement or olher riaht-ol•way use hereto <br />applied for and further agrees to remove same upon notice from the <br />Ciry and to replace public property damaged thereby. � <br />Signalure of Applicant ���- <br />80RDAYS OF�RDATE PERMIT IScISSUED AND THEREAFTER ISHTO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED 8Y THE C1TY UPON ANY STOPPAGE OF WORK ON THIS <br />PRUJECT OVER 90 DAYS DURATION. �� <br />