Laserfiche WebLink
yCtTJ <br />0 <br />1-3 co <br />H Z H <br />0=0 <br />zJHIV <br />In H <br />o <br />H t7 <br />OH <br />G)� O <br />ti C3 <br />a H <br />z <br />HH <br />C113 <br />O IN <br />O C7N <br />��lrL1 <br />z-3m <br />I-3Oco <br />Date?-_La/k <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />oc s,:,,t, Propospd Wah <br />Protect Address (if known) <br />Public Works Permit <br />c' P�9id9. DBpI. • _. (_ _. <br />Public Works Fee <br />Total Fee $ --- <br />Less Appl. Fee Paid $ <br />Balance Due <br />Attach four (4) copies of plans for proposed work - Draw to scale and note the following as applicable: <br />• Property Lines • Centerline of street <br />• Outline and dimensions of all existing and • Indicate North <br />proposed structures on the lot • Show any proposed grading changes <br />• Existing and proposed utilities • Show measurements <br />PERMIT CONDITIONS <br />1. All calls for Inspection shall be made 24 hrsin advance • phone 259-8810. <br />2. All work shall be performed in accordan,;a with this permit and current City of Everett Design and Construction <br />Standards and Specifications. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1.800-424.5555. <br />NO pwac' Vt/orhs 'pernot%R in�ti�nvd <br />Approved for Construction Date <br />FINAL INSPECTION <br />Approved as Constructed <br />r <br />rett PUBLIC WORKS DEPARTMENT <br />Ever Cedar Street <br />Everett, WA 98201 <br />Phone: 259.8810 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />U) <br />Im <br />n <br />am <br />The undersigned owner/applicant hereby agrees to hold and save harm- <br />less the City of Everett from any and all claims for damages, costs, <br />expenses, or causes of action that may arise because of installation <br />and maintenance of the Improvement or other right-of-way use hereto <br />applied for and further agrees to remove same upon notice from the <br />City and to replace public property damaged thereby. <br />Signature of Applicant Date <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE 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 />