Laserfiche WebLink
� <br />Date�l� � <br />o Application For <br />PI�iLIC WORK� PERMIT <br />O <br />PrintorTypeOn S�'g'gp �o 8�p�o $'Rg �o �$qqgp�'. <br />� T3��thC V.p7 � O�p .np P� N V�p] M�1��p � <br />. . � ���M.MLIM�~MMmM ��Mm~ MM <br />� <br />Pu01it 1VorAs PRrm'p a �� /�N <br />8140 OeOt • QT �j�� <br />Pu�lm Wo�ks Pea <br />Tolal Fee s <br />Lesa ApP� Fee Paut $ <br />Baiance Oue $ a �Q� <br />ti%II {9�19!'/!'A',::LIli}�ITI"�i'l7Pv.ir��a:�a�•••- y�rf��-'�fi, <br />• a i `w n � '�:� <br />� i � � � � <br />' ' r .� � .ti ' r .� a <br />Ii � � <br />� <br />� � <br />Describe Pr000sed Work � <br />Project Address lif known) <br />s3�.� - E�Sr <br />Attach four (4) copies o1 plans lor proposed work - Drasv to scale and nole the lollowing as applicable: <br />• Property Lines <br />w Outline and dimensions ol oll existing and <br />proposed structures on the lot <br />• Existing and proposed utilities <br />• Cen!edine ct sireet <br />• Indicale North <br />• Show any proposed grading changes <br />• Show measuremenls <br />PERMIT CONDITIONS <br />1. All cells for inspection shall be made 24 hrs. in advarce • phone 259•8810. <br />2. All wo�k shall be pertormed in accordance with this permit and current City of Everett Design and Construction <br />Standerds end Specifications. <br />3. Cell Location Underground Service 48 hrs. belore you dig. TOLL FREE NUMBER 1-800-424•5555. <br />r� <br />Approved for <br />FINAL INSPECTION <br />Approved as �onstructed <br />everelt PUBLIC WORKS DEPARTMENT <br />� 3200 Cedar Streel <br />Everett, WA 98201 <br />Phone:259�8810 <br />ACK�JOWLE�G[MENT OF CONDITIONS <br />W <br />� <br />� <br />� <br />O <br />� <br />� <br />O <br />a <br />The undersigned owner/appliwnt hereby agrees to hold and save har.n� <br />less Ihe Ciry ol Everett irom any and all claims lor tlama9es, r,ost:. <br />expenses, or causes of action that may arise because ol inslallation <br />and maintenance ot the improvement or other right-of�way use heretu <br />applied for and lurther agrees to remcve same upcn r,otice Irom the <br />City and to replace public property darnaged ihereby. <br />Signature ol Applicant Date <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITIiIN <br />780 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLEO BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVGR 90 DAYS DURATION. <br />