Laserfiche WebLink
Date�S� <br />Application For <br />PUBLIC WORKS PERMIY <br />-'rint or Type Only <br />�� Jlic Works Perm11 s <br />n <br />OId9. Oepl. s �� __ <br />Pu01ic Works Feo <br />Totul Fea $ <br />LeSs Appl. Feo Pa10 S <br />Balance Uue 5 <br />�.ui�l ,����di�nl��u :���� F,,�ar�zr- �,��t ���03 �5�-� <br />Owner Mailing Address Cil � <br />Y ZiP Phone <br />Mailing Address <br />Describe <br />Work <br />Project Address (if known� <br />Attach lour (4) copies of plans lor proposed work • Draw to sca!e and <br />O Property Lines <br />• Outline and dimensions of all existing and <br />proposed slructures on the lol <br />• Existing and proposed utilities <br />PERMI7CONDITIONS <br />ZiP Phone <br />the foltowing as applicable� <br />• Cen�erline ef stree� <br />• Indicate North <br />• 9how any proposed grading changes <br />• Shovi measurements <br />1. All calls for inspecllon shall be made 24 hrs. in advance - phone 259•881 5. <br />2. All work shni� 6e pertormed in accordance with this per.*.it and current City qf Everett Design and Construction <br />Standarifs and Specifications. <br />3. Call Location Underground Service 45 hrs. before you dig. TOLL FREE NUMBER 1•800•424-5555. <br />/`��/ / �.Ni�'�i T' /�.�G�T �'��U/,G'FO <br />Approved fof ConStrJClion Date <br />FINAL INSPECTION <br />Approved as Construcled <br />everelt PUBLIC WORKS DEPARTMENT <br />� 3200 Cedar Street <br />Everett, WA 98201 <br />Phone: 259-8815 <br />- i / �/�7 <br />�,(.C,�✓ <br />ACKNOWLEDGEMENT OF CONDITIONS <br />Z <br />O <br />The undersigned owueqapplicant hereby aqrees to hold and save harm� <br />less the City of Everett from any and all claims lor damages, costs, <br />expenses, or Causes of aclion that may arise because of installation <br />and maintenance of the improvement or other righl�of•way use hereto <br />C�ap lied lor and furlh�r agrees to remove same upon notice Irom the <br />and��c' pub�pyE'�erty damaged ihereby. <br />Si�nature of Appiidant � Dbte <br />WORK AUTHORIZED BY ?HIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFI"ER IS TO <br />BE DILIGFNTLY 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 />� <br />