Laserfiche WebLink
Date,Lp�_ 1��� <br />Application For <br />PUBL�C WQiRKS PERMIT <br />Print orType Only <br />Mailing Address <br />Des.:ribe Proposed Work <br />Project Adtlress �if known) <br />Qiy <br />/r <br />Pupli� Works Permil a <br />eiae. oeo�.+ _ �.F� <br />PUGi¢ Works Fea <br />Total Fee $ — <br />Le55 A001 Fee Pa��p 5 <br />8aianre Ouu S <br />L�p Phone <br />Atlach lour (4) copies of plans for proposed work - Draw to scale and note ihe following as applicable: <br />• Property lines <br />• Outline and dimensions ol all existing and <br />proposed structures on the lot <br />• Existing and proposed ulilities <br />• Centerline of street <br />• Indicate North <br />O Show any proposed c�rading changes <br />• Shuw measurements <br />PERMIT CONDITIONS <br />1. All calls lor inspection shall be made 24 hrs. in advance- phone 25$•$$10. <br />2. All work shall be pedormed in accordance with this permit and current City of Everetl Design and Construction <br />Standards and Specifications. <br />3. Call Location Underground Service 48 hrs. belore you dig. TOLL FREE NUMBER 1•500-424-5555. <br />� f ;� � r <br />.�� ���'�:, ���..�< y�..�.<;�",��' ����-�,�/ <br />> <br />`�� <br />����� <br />� <br />Approvr.d for Construction <br />FINAL INSPECTION <br />Approved as Constructed <br />everett PUBLICWORKSUEPARTMENT <br />� 3200 Cedar Street <br />Everet6 WA 98201 <br />��,o�,, zse�aa�o <br />ACKIJOWLEDGEIdENT OF CONDITIONS <br />� <br />O <br />F� <br />� <br />O <br />a <br />The undersiyned ov:ner/applicanl hereUy agrees to hold and save harm� <br />less ihe City of Everelt Irom any and all claims lor damac�es, cosls. <br />expenses. or causes of action �hat may arise because of inslallat�on <br />antl maintenance of the improvemenl or other right-ol-way use he�eto <br />apphed lor and luriher ac�rees to remove snme upon notice from the <br />Da�e City and to reUlace public property damaged ihereby. <br />Date <br />Signature ol Applicant p,�i,. — <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIiJ <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS Tp <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT h1AY 6[ <br />C�NCELLE� BV THE CITY Uf`ON ANl' STOPpqGE OF �NORK ON TIiIS <br />PROJFCT OVER 90 DAVti DUI7ATION. <br />