Laserfiche WebLink
Hx O H <br />C� � � <br />C�H <br />9Hfn <br />� <br />K � <br />H �1 <br />� H � <br />y <br />Hz <br />��C <br />��g <br />�� n <br />t"y� <br />Ny <br />� <br />gdy <br />��� <br />zyv, <br />HO(n <br />Date�/,r i�ri <br />� � <br />Applica!ion For <br />PUBLIC WORKS P'ERMIT <br />Print or Type Only <br />Mailing <br />Applicant <br />Gity <br />, Fu�L: NbrAs Pe�m/il; • _ <br />pi49 Da01. • Y /�� <br />PuelmworxsFae S <br />,o,a� F« — <br />lese APpI iee Pn�a $ <br />eal�nco cuo <br />Desc;ribe Proposed Work _L7���� �``" n H �� !P LLf/�A� Si}],�q�P 7Yr2��J�4� <br />. <br />Project Address 1if known) <br />Attach lour (4) copies of plans for proposed work - Draw lo scale and note the following as applica6le: <br />• Property Lines • Centerline ol street <br />• Oulline and dlmensions of all eaistin9 and • Indicale Ncrih <br />proposed slrucW res on the bl • Show any proposed g�ading changes <br />• Existing and proposed ulililies • Show measuremenis <br />Phone <br />PERMIT CONDITIONS <br />1. All calls (or inspection shall be ma�e 24 hrs. in advance - phone 259•8810. <br />2. All work shall be pedormed in accordance with this permit antl currenl City of Everett Desiqn and Construction <br />Standards and Specifications. <br />3. Call Location Underground Service 48 hrs. 6elore you dig. TOLL FREE NUMBER 1•800•424•5555. <br />����c� cc/uzl��f�r,�� /�/c�° �e�u�l� <br />Approved lor Cons�rudion Date <br />FINAL INSPECTION Dale <br />Approved as Constructed <br />�PUBLIC WORKS DEPARTMENT <br />�, 3200CedarSireel <br />�d04ETT Everett, WA 98201 <br />Phone:259�8810 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />W <br />H <br />� <br />� <br />� <br />O <br />� <br />� <br />0 <br />a <br />The undersi9ned owner/applicant here6y agrees to hold and save harm� <br />less Ihe City ol Everelt Irom any and all claims lor damages. costs. <br />ezpenses, or wuses ol aclion ihat may arise hecause ol installation <br />and mamtenance ol lhe improvement or other ri9hDol�way use hereto <br />applietl lor and luriher aqrees to remove same upon notice irom thc <br />Cily antl to replace public property damaged therehy. <br />SignaWre ol AppliCant Date <br />VlORK AUTHORIZED BY THIS PERMIT MU`'T BE STARTED WITHIN <br />180 DAYS OF DA1E PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BYTHE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />