Laserfiche WebLink
Date_i' ' S <br />Application For <br />PUBLI�� VI�ORKS PERMIT <br />Print or Type Only <br />3� <br />ng Address <br />Describe Proposecl Work <br />Pro�ect Address (if known) �`�� � <br />Publlt Worke Permil • �`� � � � <br />i� <br />pltlg. Oepi. � � <br />Pue�ic wo�ks Fco S <br />Total Feo - <br />LeasPpP� Fee PaiJ S <br />eaia��a o�a S ?_c�, O� <br />�8�9 <br />cuy <br />City <br />Attach four (4) copies of plans for proposed work - Draw to scale and note the following as applicable: <br />• Property Lines <br />•(�utline and dimensions of all existing and <br />proposed structures on the lal <br />• Ezisting and proposad utilities <br />'FlNAL INSPI <br />Approved as <br />everett <br />e <br />• Centerline of street <br />• Indicate Norih <br />• Show any proposed grading changes <br />• Show measurements <br />PERMIT CONDITIONS <br />1. All calls for insper,tion shall De made 24 hrs. in advance - phone 259•881 5. <br />2. All work shall be performed in accordance with this permit and cu« ent Cily of Everett Design and Construction <br />Standards and Specifications <br />3. Call Location Underground Sorvice 48 hrs. betore you dic�. TOLL FREE NUMBER 00-424-55�5. <br />�..�.._ _,C�.,.<��,� �,�� aEc��E��� A,�v <br />,S if/c�C�J .(��'/r El.�Ay /•�l L ,:J�'G iiDN <br />P�nT f�ll�/✓ .S'F�dGC b�'� 1't,�SiQLLFG' <br />ST�tNO.d/�� sf ?c'� <br />PUBLIC WOHKS DEPARTPAENT <br />3200 Cedar Street <br />Everett, WA 98201 <br />Phone:259•8815 <br />Date <br />S,./�7C�iit� D�I <br />.%'Eiz C� Ty <br />ACKNOWLEDGEMENT OF CONDITIONS <br />W <br />� <br />� <br />� <br />Z <br />O <br />� <br />� <br />O <br />a <br />7he undersigned owner/applicant hereUy ac�rees to hold and save harm- <br />less the City c` C-verett irom ar�y and all claims for dama6es, costs, <br />ezpenses, or ceus^s ol action ihat ,nay arise because ot installalion <br />and mainlenance ot the improvement or olher righPohway use herelo <br />applied lor and Wrther agrees to remove same upon notice Irom Ihe <br />City and to replace public properry damaged thereby. <br />� � n �\M � \ C�. �.Q..��a �� <br />Signa ie of Applicant Date <br />WORK UTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />180 DA S OF DATE PERA7IT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLET�ON. THIS PERMIT MAV BE <br />CANCELLED 8Y THE CITY UPON AN1' STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />Z <br />0 <br />� <br />� <br />m <br />�. .. <br />--1 'T1 <br />H �-I <br />N 2 <br />m <br />0 <br />co <br />mo <br />� <br />O 3 <br />m <br />_ -�i <br />m <br />.� <br />cZ <br />�s <br />.-� .. <br />� N <br />oz <br />�a <br />3 <br />--i m <br />s <br />m� <br />N <br />0 <br />om <br />C N <br />m �' <br />_� <br />.� m <br />D <br />� <br />2 <br />� <br />Z <br />--1 <br />x <br />N <br />_ <br />0 <br />-i <br />� <br />m <br />d <br />