Laserfiche WebLink
Date���fL-�Fa� <br />.<� <br />Applicalion For <br />PUE3L�C V9/ORKS PERMIT <br />Print or Type Only <br />Applicant <br />Mailinq Hddress <br />Describe Proposed Work � � ' � � � s� <br />Project Address (if known) <br />Iw'; <br />PubLc Works Pa�ml� /�� % ^7 <br />plep. DePI. a �LL� `- �7 � / �) <br />PWImWmksFoo S <br />Tolnlfec <br />Less Appl. Fae Paid S <br />Daiance0ue 5 <br />2ip Phone <br />Atlach tour (4) copies of plans lor proposed work - Draw to scale �nd nole the following as applicable: <br />• Property Lines • Centedine ot slreel <br />• Outline and dimen;ions ol all existing and • Indicate North <br />proposed sVuclures on ihe lol • Show any proposed giadinc7 chanqes <br />• Existing . r�d proposed utilities • Show maasurements <br />PERMIT �ONDITIONS <br />1. All ca!Is for inspection shall be made 24 hrs. in advance - phone 259•8R10. <br />2. All work shall be peAormed in accordance with this permit and current City of Everett Design and Construction <br />Standards and Specilications. <br />3. Call Lor.ation Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1•800•424-5555. <br />�(%�... f r. G Lt-`�"° /�. /� <br />�- <br />% ; . ,. i /( .. j . . "i <br />Approved lor Gons�ruction Date <br />PIN/',L INSPECTION Dale <br />App:oved as Constructed <br />everelt PUBLIC WORKS DEPARTMENT <br />�� 3200 Cedar Sireet <br />Everelt. WA 98201 <br />Phone: 259�8810 <br />� �f�� • ~ <br />/i�'-_ - '>'' <br />fo <br />O <br />ACKNOWLEDGEMENT OF �ONDITIONS <br />The undersigned owner/applicant hereby agrets to nold and save harm� <br />less the Cily of Everell Irom any and ail claima lor damages, costs, <br />expenses, or causes of action that may arise because of installation <br />and maintenar,ce ol the improvemen� or other right-oFw2y use hereto <br />applied �or anA fur�l•�er agrees lo remove same upon nolice irom Uie <br />City and to replace public property damaged thereby. <br />Si�nature ol Applicant Date <br />WORK AUTHURIZED BY THIS PERMIT MUST BE STARTED WITHW , <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO I <br />BE DILIGENTLY PURSUED TO GOMPLETION. THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS � <br />PROJECT OVER 90 DAYS DURATION. <br />----..._ -- _. _..- � ----_ .. . .. _--- ------ -.. ---_' <br />I. <br />