Laserfiche WebLink
Date��� <br />Application For <br />�UBi�IC W�RKS PERMIT <br />Print or Type Only <br />Applicant <br />Describe Proposed Work <br />Project Address (if knowr�) <br />�1�M� <br />iiling Address <br />Ci�y <br />U <br />Zip <br />Pub�m Y:o't. Permi; e ' <br />Bme Deal • _.�j// Id :7 IO <br />puolleY:orhsFeo 5 <br />Total Fea <br />LevAppl FeePaid $ <br />Baiance Due 5 <br />AUach tour (4) copies ot plans for propose�l work - Draw to swle and note the following as applica6le: <br />• Property Lines • Cen�erline of s�ree� <br />• Outline and dimensions ol all existing and • Indicate Norih <br />p�oposed slrucWres on the lot • Show any proposed gradin9 changes <br />• Existing and proposed utilities • Shuw measuremenls <br />R <br />d' � <br />Phone <br />PERMIT CONDITIONS <br />1. All calls lor ine�pection shail be made 24 hrs. in advance - phone 259•88� 5. <br />2. All work shall be perlormed in accordance with ihis permit and current City of Everett Design and Construction <br />Slandards and Specilications. <br />3. Call Localion Undarground Service 48 hrs. beiore you diq. TOLL FREE NUMBER 1-800•424•5555. <br />qpproved for Consiruction <br />FINAL INSPECTION <br />Approved as Consiructed <br />everelt PUBLIC WORKS DEPARTMENT <br />� I 3200 Cedar Slree� <br />�I Everett, WA 98201 <br />� Phonc:259-8815 <br />V� � � <br />� �� e. <br />�e <br />Date <br />Date <br />W <br />F- <br />��p <br />�/ <br />� <br />� <br />PCKNOWLEDGEMCNT OF CONDITIONS <br />The undersigneA owner/applicant hereby aqrees to hold and save harm� <br />less the City of EvereU from any and :.tl claims lor damages, costs. <br />ezpenses, or cau;es of actico that may arise because o( installation <br />and maintenance of ihe improvemenl or other rigM�ol�way use hereto <br />applied for and further agrees to remove same upon notice Irom the <br />Ciry and lu replace public property damageA thereby. <br />Signature of ApP�icanl Dnte <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITIIIN <br />1B0 D.1YS OF DATE PERA�IT IS ISSUED AND THEREAFTER IS i�0 <br />BE DILIGENTLV i URSUEO TO COMPLETION. 1'HIS PERMIT MAY F3E <br />CANCELLED BY THE CITY UPON /1N'f STOPPAGF CF WORK ON THIS <br />Pf;OJECT OV6H 90 UAYS DURATION. <br />