Laserfiche WebLink
Date��� J � <br />Application For <br />PUBLIC WOFiKS PERMIT <br />Print or Type Only <br />Owner <br />City <br />� �3/ <br />�s�� <br />Public KoiAs Permit • � <br />l ` <br />B1�p. Dept. c _ <br />PWlic Worts Fae S <br />TO�aI FPe <br />�asy qDo�� Fee Pa�U � <br />Ba�ancn Oua $ �� <br />I ��4'_ �1 7� <br />U JC <br />Ph�ne <br />qPp�i�� NailmgAddress Gity Z�p Phone <br />Describe Proposed Work <br />Project Address (if known) <br />IJ <br />Attach four (4) copies of plans for proposed work • Draw to scale and note the following as applicable: <br />• Property Lines <br />• Outline and dimensions of all existing and <br />proposed structures on the lol <br />• Ezisting and proDosed utilities <br />• Cenlerline ol stree: <br />• Indicate North <br />• Show any proposed grading �hanges <br />• Show measurements <br />PERMITCONDITIONS <br />1. All calis tor inspection shall be made 24 hrs. in advance • phone 259•8810. <br />2. All work shall be pedormed in acwrdance with this permit and current City ol [veretl Desic�n and Construclion <br />Standards and Specilications. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE N1111tOER 1•800•424•5555. <br />�� <br />� `G ��� � � aa <br />Approved for Con p ion Date <br />�� / �-/f�- �� C <br />FINAL IIdSPECTION Date <br />Approved as Constructed <br />everett PUBUC WORKS DEPARTMENT <br />U3200 Cetlar Streel <br />Everett, WA 98201 <br />Phone:259�8810 <br />ACKtJOWLEDGEMENT OF CONDITIONS <br />W <br />H <br />�w <br />�I <br />� <br />� <br />� <br />� <br />O <br />a <br />The undersigned oH nedapplicant hereby agrees to hold and save h-.- r� <br />less Ihe City ot Everett irom any and ali claims tor damages. • ���ts. <br />ezpenses, or causes ol acUun hat may arise because ot inslau �„� � <br />and maintenance of O�e impr vL ment or other n�ht-ol�way use herelo <br />applied lor and lurther a9re �o remove same upon notice Irom the <br />City and to replace public p o rty damaged Ihereby. <br />ure of <br />� � <br />� <br />DaIP <br />WORK AUTHOFiIZ[ki BY THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO GOMPLETION. THIS PERMIT MAY BE <br />CANCELLED BY THE GITY UPON ANY STOPPA�.iE OF N,'ORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />