Laserfiche WebLink
Date����' <br />�� 1�/l _.. '/ 'j <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />1 <br />DescriL+e Proposed Work <br />Address <br />Proiect Address lif known) 3��J — E-r"2�� ,�rC �4', <br />��PiP� y <br />Ci,Y Zip <br />City Zip <br />Public \YOrFs Pwmi� � _�L_�L � �_, <br />e e� o, o� ,.—�9�Z. Z�f��l�— <br />Puei¢ wo�ws Fce <br />Totnl Fce $ — . <br />Less Nnpl Fee Paid S_ <br />�— <br />Balancc Uuo $ � �� O <br />Attach four (4) copies o1 plans lor proposetl work - Draw to scale and note Ihe tollowing as applicable: <br />• Property Lines • Centerline ol street <br />� Outline and dimensions of all existi�g and • Indicate North <br />r proposetl structures on the lot • Show any proposed grading changes <br />- • Ezisting and proposed utilities • Show measurements <br />PEf ..._ ..., <br />7.A <br />2.A <br />c <br />3.0 <br />�7�i'�/�ra/�_ �5'���'7 <br />Approved lor Cons�ruC�ion Date <br />FINAL INSPECTION Date <br />Approved as Constructed <br />everett PUBLIC WORKS DEPARTMENT <br />� 3200 Cedar Stree� <br />Everett, WA 98201 <br />Phone:259�8810 <br />,�- <br />Phone <br />Phone <br />�nd Construction <br />>4-5555. <br />W <br />� <br />� <br />� <br />� <br />O <br />a <br />ACKNUWIEDGEM�NT OF CONDITIONS <br />The undersigneA ovme�/applicant hereby agrees to hold and save harm� <br />less the Cily of Everett from any and all claims for damages, costs, <br />ezpenses, or causes ol action that may arise because of installat�on <br />and maintenance of lhe imFrovemenl or other right•ol�way use herelo <br />a �e or and further agrees to remove same upon notice Irom the <br />i�y and replace public property damaged thereby. <br />Si ature ol App ant � Date <br />WORK AUTHORI � BY THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DA E PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY 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 />