Laserfiche WebLink
/ <br />Date� � <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />Public Wmks Permll ♦ <br />eiacowi.• �T �S ---._ <br />Pu�lic Wo�ke Fee <br />TalalFee S <br />Leaa AOo�. Fee Peid S <br />Balancn Due S <br />Owner Mailing Address �'' Ciry Zip Phone <br />�J� �� ���n�.o Co.-J� r �?� i - /�� -� /1%lt> `�/�f'�✓( !L.J w'� �a�o�.1 <br />Applicant � Mailing Address City Zip Phone �` <br />/ J�� � �elr��/ <br />(� �� (J (O <br />Describe Proposed Work �"�'� '� h-� ��.T� C�rL'�-� <br />Pro�ect Address (if known) <br />Attach lour (4) copies of plans lor proposed wo�k • Draw to scale and nole the lollowing as applicable: <br />• Property Lines <br />• Outline and dimensians of all existing and <br />proposed structures on the lot <br />� Existing and proposed utilities <br />PERMIT CONDITIONS <br />• Centerline of streel <br />• Indicate North <br />• Show any proposed giading changes <br />• Show measurements <br />1. All calls for inspection shall be made 24 hrs. in advance - phone 259•881 5. <br />2. All work shall be performed in accordance with this permit and current City of Everett Design and Consiruction <br />Standards and Specilications. <br />3. Cali Location Underground Service 48 hrs. be(ore you dig. TOLL FREE NUMBER 1•800-424•5555. <br />/�� /�U�2iC <br />�_����i��� <br />Gl��.i/'�S� ��i�i��i% <br />, �l <br />�: / � ✓ `'�� � <br />l <br />/ � <br />Approved lor Construction Date <br />FINAL INSPECTION <br />Approved as Constructed <br />everett PUBLIC WORKS DEPARTMCNT <br />�� 3200 Cedar Slre�t <br />Everett, WA 98201 <br />Phone:259-8875 <br />Date <br />ACKNOWLEDGEMENT OF CONDITIONS <br />W <br />H <br />� <br />� <br />O <br />� <br />� <br />O <br />a <br />The undersigned owne:/applicant hereby agrees to hold and save harm- <br />less ihe City of Everett Irom any and all claims for damages, cos�s, <br />expenses. or causes ol ac�ir,n that may arise because ot ins�allation <br />and rnaintenance of the i��provemenl or other right�of-way use hereto <br />applied for and lurther aarees to remove same upon no�ice Irom the <br />City and to replace public properry damaged Ihereby. <br />Signalure ol ApP��cant Date <br />WORK AUTHORIZED BY THIS PE9MIT MUST BE START[D WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS �fq <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY ;-IE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF INORK O�J TI115 <br />PROJECT OVER 90 DAYS DURATION. <br />