Laserfiche WebLink
Cyy+7 <br />aHr~n <br />i_3 a <br />H zH <br />< 1-3z <br />� yH <br />H r <br />o <br />H l7 <br />OH <br />Hoo <br />Ch O <br />c1 ia 0❑ <br />N <br />�rAH <br />N <br />Cl C UJ <br />r� r <br />zH1:4 <br />HOW <br />� s <br />T '+ <br />Date 1' <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />Zip <br />Public Mike Pa•ma • Q <br />Bldg DePl • _ , <br />Public PJork. Fee <br />TOW Fee <br />Lea. APPI Fee Paid $ <br />aalance Due <br />Applicant Mailing Address City Zip Phone <br />Describe Proposed Work <br />Project Address (if known) <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 hrs. in advance - phone 259.8810. <br />2. All work shall be performed in accordance 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 />Approved for Construction Date <br />FINAL INSPECTION Date <br />Approved as Constructed <br />a <br />PUBLIC WORKS DEPARTMENT <br />3200 Street <br />Everett,tt, WA WA 98201 <br />Phone. 259.8810 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />Z <br />0 <br />The undersigned owner/applicant hereby agrees to hold and save harm- <br />less the City or 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-ol-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 Dale <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 />