Laserfiche WebLink
TYPE OR PRINT ONLY <br />AppliWtion For <br />PUBLIC WORKS PERMIT <br />PUBLIC WORKS DEPARTMENT <br />3200 Cedar Street <br />Everett, WA 98201 (425) 257-8810 <br />lU J�I�jIN�N 0 710U0 <br />�. Q <br />Mailing <br />L� <br />Date _ IVIzZ/Cj� ^ <br />Public Works Permit N �/�l��l <br />Building Permit p <br />Public Works Fee $ � <br />Ciy Zip Phone (�1�}�v7U-S3A'� <br />Applicant Mailing Addross Ciry Zip Phona <br />Describe Proposed Work <br />PROJECTADDRESS (if known) Z2-O �J� �VcfGCv �I I <br />Attach four (4) copies plans for proposed work - Draw to swle and note the following il applicab!e: <br />• Property Lines • Outline and dimensions ol all eKisting and proposed stnictures on tt�e lot • Existing and proposed utilities <br />• Centerline of street • Indicate North • Show eny proposeA grading changes • Show measurements <br />DO NOT WRITE RELOW THIS LINE <br />PERMIT CONDITIONS: <br />1. All calls for inspection shall be made 24 hours in advance - phone (425) 257-8810 <br />2. All work shall be peAormed in accordance with this permit and current City of Everett Design and <br />Construction Standards and Specitications. <br />3. Call Location Underground Service 48 hrs. be(ore you dig. TOLL FREE NUMBER 1-800-424-5555. <br />�� !'� h(%B�� j p�l (UUeO ��7V) GY�tX�� �U/Zz/ 1� <br />I � <br />W <br />� <br />� <br />� <br />� <br />O <br />� <br />� <br />O <br />a <br />ACKNOWLEDGEMENT OF CONDITIONS <br />,�1j�� The undersigned ownedapplicant heroby agroes to hold aM savo harmless <br />, �{�l 0..EJ� I Ur72 I�C( the City of Everetl from any and all claims for damages, cosb, expenses, or <br />�prove or ons ru f n a e causes of action that may anse bacause ot installatlon and maintenance of tlie <br />�/'/� ^/�' improvement or other rightvf•way use hereto epplied for and lurther egreos to <br />�� /�,,,µ_ // _� cJ _�� remove same upon notice from the ry anA to replace public property dam• <br />'•7 Z!�' aged thereby. <br />FINAL INSPECTION Date <br />Approvetl as Constructed <br />igne re o p n <br />VdOfiK AUTFpRI�D BY iHIS PERMR MUST BE STAfl1ED WfTHIN 180 DAYS OF DATE pERMfT IS INA T}EREAFTER IS TO BE DIl10ENTLy RIRSUEp 7p <br />COMPLEf10N.7}iIS PERMfT MAY BE CANCELI.ED BY TFiE CRY UPON M1Y STOPPAGE OF WOFiK IXJ THS PpQECT OVER 90 DAYS WRATION. <br />