Laserfiche WebLink
oete.�1 <br />Applicetion For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />r <br />� <br />PuDiic Worka Perpmit • <br />BIaO. Depl • Ci �T�� <br />Pu01i� N'orke Fee <br />Totsl P.e s <br />Less �oot Fen P��E i <br />B�I�nce Due i <br />� <br />� l �I V <br />Deecribe Proposed Work � <br />Pro�ect Address (i( known) <br />Attech four (4) copfea of plans for proposed work - Draw to scale end note the following as epplicable: <br />• Property Lines • Canterline of street <br />• Outline and tlimensions of all existing and • Indicete North <br />prop, aed etructures on the lot • Show eny proposed grading changes <br />• Existiny and proposed utilities • Show measurements <br />PERMIT CONDITIONS <br />1. All calls ic�r (nspaction shail be mede 24 hrs in edvance • phon�a 259•8815. <br />2. All work shall be peAormed in accordence with this permit and cwre�t City ot Everett Design end Conatruction <br />Standards and Specificationa <br />3. Call Location Underyround Service 48 hrs before you dig. TOLL FREE NUMBER 1-800-424•5555. <br />/� �'7-8? <br />/ G�Z /C �02�5 f�/ZMiT /IIOT �PFQ!//.e6"O <br />ApprovedtorConshuctwn Date <br />FINAL INSPECTION Date <br />Approved as Constructed <br />everett PUBLIC WORKS DE�ARTMENT <br />� 3200 Cedar Street <br />Everett, Wq g8201 <br />Phone: 259•BBt 5 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />W <br />� <br />� <br />� <br />� <br />� <br />O <br />a <br />The undersigned owner/applicant hereby egrees to hold and aeve herm- <br />less the City of Everett Irom any and all claims for damages, ccsts, <br />expenses, or causes af act(on thet may erise becauae of Inatallatlon <br />and maintenence of the improvement or other right-of•wey use hereto <br />applied for and furthe� egrees to remove same upon notice from the <br />City arid to replace public property damaged thereby. <br />Signature of Applicant Date <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. I <br />