Laserfiche WebLink
��� <br />TYPE OR PRINT ONLY <br />� <br />{ cation For <br />PUBLIC WORKS PERMIT <br />oPUBLIC WORKS UEPARTMENT <br />a 3200 Cedar Street <br />gEverett,WA98201 259-88�10 <br />�8885�8� 8 <br />.. .t������ � <br />Describe Proposed Work <br />PROJECT ADDRESS (if known) <br />Nru <br />City <br />Attach four (4� copies oi plans for pmp:�sed work - Draw to scale and note the tollowing if applicable: <br />� <br />Date �2/"1 / <br />Public Works PertnR N �/�/-� � <br />Building Permit N _,�]]_Kl,7 <br />� <br />Public Works Fee E � <br />2ip Phone <br />FE@ 1 <br />•Property Lines butline and d��nensions of al� existing and proposed structures on ihe lot •F�cisti�g and proposed utilities <br />•Genterline of street •Indicate North "Show any proposecl grading changes •Show measuremenls <br />PERMIT CONDITIONS: <br />1. All calls for inspection shall be made 24 hours in advance - phone 259-8810. <br />2. AII work shall be pertormed in accordance with this permit and current City of Everett Design and <br />Const!uction Standards and Specifications. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800-424-5555. <br />�, r9ti� �,� <br />5 ���►�� <br />�; �t� <br />roO��Ci� ✓vh o�1b -�G �'1��t aF � �lwk� <br />c� zs �.-�,✓ �,.b�z vvo►rks �S�C-�„-s <br />� ��(d. <br />��, �� S� �Q�� � w ,�. <br />��� � �� S� ��� �� <br />`---� � � � ✓'e"`J � u��-� � , .,�- <br />�,�' %; � � <br />�� <br />� <br />, ��1� , <br />'- �v /i �� <br />ACKNOWLEDGEMENT dF CONDVTIONS <br />The undersigned owner/applicant hereby agrees to hold and save harmless <br />the Ciry of Everell from any and all clai�ns for damages, costs, ezpenses, or <br />causes of action ihat may arise because ot fnstallation antl maintenance of <br />ihe Improvement or other righbof-way use hereto applied for and turther agrees <br />to remove same upon notice fmm he Cily and to replace public property <br />damaged the�eby. <br />SlgnatweotAppliwnt � ate <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN 180 DAYS OF DATE PERMR IS ISSUED AND THEREAFfER IS TO BE DILIGENTL PURSUED TO <br />COAIPLETION. THIS PERMIT MAY BE CANC�LLED BY THE CI1Y UPON ANY STOPPAGE OF WORK ON THIS PHOJECT UVER 90 DAYS DUR4TION. <br />W <br />!"'° <br />� <br />� <br />� <br />O <br />� <br />� <br />� <br />� <br />� <br />O <br />a <br />