Laserfiche WebLink
���' <br />��� <br />�HxC~n <br />Hx� <br />�H� <br />"��H� <br />y (/� H <br />i�y� <br />C) H <br />��g <br />iji Y �] <br />�H� <br />rr H <br />g� <br />f] t7 V� <br />��th <br />x H p� <br />HOC� <br />� r �', <br />I �� � <br />�i � :0 i <br />Date � n-t�.n "D � , <br />Application For <br />PUBLIG WORKS P►�F�MIT <br />Print or Type Only <br />Mailing <br />Mailing <br />Describe Proposed Work <br />Proiecl Address (if known) <br />Gity <br />Public Woiks Pcrmit + <br />emy. oe�i.. <br />Pu�licWoihsiea S, <br />ro�ei foe <br />LessFpplFeo'vid 5 <br />0alance �uo S <br />Attach tour (4) copies ot plans for proposed work • Draw to scale and note the following as applicable: <br />• Property Lines ,• Centedine of slreet <br />• Outline and dimensions of all existing and e Indicate Norih <br />proposed strucWres on the lot • Show any proposed grading changes <br />• Existing and proposeC utilities • Show measurements <br />PERMIT CONDITIONS <br />1. All calls tor inspection shall be made 24 hrs. in advance - phone 259•881 5. <br />2. All work shall be performed in accordance wilh this permit and curren� City of �iverett Design and Consiruction <br />Standards and Specilications. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800•424•5555. <br />�//��1C G�o.�,er 1�,E,cm�r .�r/oT ��, <br />Approved for Construction Date <br />FINAL INSPECTION Date <br />Approved as Conslructed <br />everett PUBLIC WORKS DEPARTMENT <br />� 3200 Cedar Slreet <br />Everett, WA 98201 <br />Phone: 259-8815 <br />/O/27/87 <br />��-� � <br />` <br />� <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undersigned owner/applicant hereby agrees to hold and save harm- <br />less the City of Everel� irom any and all claims for damages, cosls, <br />expenses, or causes of action that may arise because of installation <br />and mainlenance of the improvement o� other right-of�way use herelo <br />applied for and lurther agrees to remove same upon notice from the <br />Ci�y and to replace public property damaged ihereby. <br />Si�nature of Applicant Date <br />WORK AUTHORIZED B'f THIS PERMIT MUST BE STARTED WITHIN <br />1B0 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MA'/ BE <br />CANCELLED BY THE CIN UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />� <br />