Laserfiche WebLink
Dat� <br />Applicalion For <br />PUBLIG iNORKS PERMIT <br />Print or Type Only TO POSTING_..-3 -- �"- �-.� <br />Pu01ic WorAs Pe mp • ✓ "� _ /� � <br />BIJp. DePL • �, J � <br />v�oi�o wo�k. r�� <br />Taeivee S <br />Leu Pppl. iee PeiE i <br />Bal�nce Oue s 2Q 00 — <br />� � �37- 63�,� <br />Z�P Phone <br />Describe Proposed Wo�k �% � <br />Project Address (if known) <br />Attach lour �4) copies of plans for proposed work -"bra� <br />• Property Lines <br />• Outline and dimensions of all existing and <br />proposed structures on the lot <br />• Existing and proposed utilities <br />PERMIT CONDITIONS <br />to scale and note the toilowiny as applicable: <br />• Centerline ol street <br />• Indicate North <br />• Show any proposed greding changes <br />• Show measurements <br />1. HII calls for inspection shall be made 24 hrs. in advance • phone 259•8815. <br />2. All work shall be pertormed in accordance with this permit and current City of Eve�ett Design end Construction <br />Standerds and Specifications <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800•424•5555. <br />� GUr».�' TG �F' Oar.�- PE.� 9��.�cr�EU <br />S'irE i'�.q.�/ 1>9rEV .�-za �y� , <br />��lc � � J/ZO/B�C <br />Approved for Con ructio.`�/L'r//�� ��� �Date <br />�I <br />✓ /b � / �(j <br />FINAL INSPECTION Date <br />Approved as Constructed <br />everett PUBLIC WORF:S DFPARTMENT <br />� 3200 Cedar Slreet <br />Everett, WA 9d207 <br />Phone: 259-BBi 5 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />W <br />F- <br />� <br />� <br />O <br />� <br />� <br />O <br />a <br />The undersigned owner/applicant hereby agrees to hold and save harm- <br />less tho City ot Everett from any and all claims lor damages, costs, <br />expenses, or causes ol action that may arise because of installation <br />and mainlenance ol the improvement or other right•of-way use hereto <br />a lor and turther agrees to remove same upon notice from the <br />ity an to replace public property dama9ed thereby. <br />f <br />Signa ure of Applicant Date <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />1B0 DAYS OF DATE PERMIT IS ISSUED AND TFIEREAFTER IS TO <br />BE D�LIGENTLY 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. <br />