Laserfiche WebLink
Date� � <br />� <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />icanl <br />Mailing Address <br />Mailin9 Address <br />� I Pubhc Works P�crmi�) _I�� <br />�Iif9 DeP�. a � --.. <br />— 'I <br />PubLc 1Vorks Fee <br />Tolal Fee S <br />LessAnpl FeePaid $ <br />�ala�me Due $ <br />' �. �"�� � 1��,� <br />Ci�y Zip P <br />���c)%-, i-�( <br />Ciry 2ip p <br />Describe Proposed Work �.—�� ���l lv�• �« � �( ��- ������n <br />7 7c'i <br />Prolect Address (it known) <br />Attach lour (4) copies of plans lor proposed work - Draw to scale antl note the fo!lowing as a <br />Approved lor <br />• Properly Lines <br />• Outline and dimensions ot all existing and <br />proposed structures on the lot <br />• Ezisting and proposed u�ilities <br />• Centerline of sireet <br />• Indicate North <br />• Show any proposed grading changes <br />• Show measurements <br />PERMIT CONDITIONS <br />7. All calls for inspr.ction shall be made 24 hrs. in advance � phone 259•8810. <br />2. All work shall be pertormed in accordance wilh this permit and currert City of Everetl Design and Constmction <br />Standards and Specifications. <br />3. Call Location Underground Servica 48 hrs. 6etore you dig. TOLL FREE NUMBER 1-800-424•5555. <br />FINAL INSPECTION <br />Approved as Constructed <br />everetl PUBLICWORKS�EPARTMENT <br />� 3200 Cedar Sheet <br />Everelt, WA 98201 <br />Phone:259�8810 <br />, . <br />! /y,G i !�f1�1=��i <br />�3. y.j . .a � <br />ACKNOWLEDGEMENT OF CONDITIONS <br />W <br />H <br />�/ <br />� <br />� <br />The undersigned ownedapplicanl hereby agrees to hold and save harm� <br />- f�ss the City of Everett Irom any and all claims lor damages, costs. <br />expenses, or causes of action that may arise because ol installation <br />and maintenance ol Ihe improvemenl or other righhobway use hereto <br />applied lor and lurther agrees to remove same upon notice Irom the <br />Date Cily and lo replace public property damaged thereby. <br />Date <br />Signalure ol Applicant Date <br />'NORK AUTHORIZED 8Y THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIG�NTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THI'" <br />PROJECT OVER 90 DAYS DURATION. <br />