Laserfiche WebLink
Application For � / <br /> PUBLIC WORKS PERMIT Date ��� �I� —_ <br /> � PUBLIC WORKS D[PARTMENT Public Works Permit k ��O�Y <br /> 3200 Cedar Sheet � <br /> Everetl,WA 98201 259-8810 Building Permit N —_ <br /> i <br /> �YPE OR PRIIJT G'NLY Public Works Fee 5. — <br /> p��� Mailin Addres� � !�ity L� Phone <br /> � qt� �� <br /> Applicart Mailiag Address , City Zip Phone <br /> Describ Proposed W�rk ��-.�� � i <br /> � � � <br /> � <br /> PflOJECT ADDHESS(if known) � ✓ � — � <br /> Attach four(4)copies ol plans for proposed work-Dr..w to scale and note th Ilowing if applicable: � <br /> •Property Lines •Outlire and dimensionc of all ezisting and proposed siruclures on ihe lot •6cisting and proposcM utilities O <br /> •Centedine of streti 'Indiwte NbAh •Show any proposed grading changes •Show measurements � <br /> DO NOT WRITF BELOW THIS LINE <br /> PERMIT CONDITIONS: Z <br /> 1. All calls for inspection shall be made 24 hours in advance- phone 259-8810. O <br /> 2.All work shall be pertormed in accordance with this permit and current City of Everett Decign and <br /> Construction Standards and Specifications. <br /> 3. Call Location Underaround Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800-424-5555. � <br /> ��� �I� �U/ �h.s�u�v✓ GJ 33�1-?�3 -� �hs�c�I , � <br /> s" a <br /> �e�IZr�c C✓�,vetnr�i C-' P�,�k ,�r� s�fr-;� �� <br /> 0 �� <br /> �S�d ���n �3�1 <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> /��7 The undersigned cwner/applicant here6y agrees to hold and save hartnless <br /> ^ //y/ �� ,. �2 /� tne City of Everett from any and all claims for damages,costs,expenses,or <br /> � � �� causes of action that may anse bzcnuse of installation and maintrnance ol <br /> Ap, ovedbrCon t tion �e theimpmvemen:wothernght-of-wayusehoretoappliedlorar:dfutlherag,--_ <br /> n to remove same upon notice from Ihe City and to replace puDlic property <br /> i ���-_ /� _- Z (!'-�/ 9 dama9ed the2Cy. <br /> FINAL INSPECTIOM Uate <br /> Flpproved as Constmcted l' QQ� <br /> naWre of Appliwnt Da'te <br /> WOIiK AUTHORI2E:D BY THIS PERMIT MUST BE STARTED WI'THIN�80 DAYS OF DATE ERMIT IS ISSUED AND THEREAFTFR IS TO BE DILIGENTLY PURSUED TO <br /> COhIPLETION.THIS FERMIT MAY BE CANCELLED BY THE CIN UPON ANY STOPPAGE OF WORK ON THIS PRQIECT OVER Ml DAY$DURATIUN. � <br />