Laserfiche WebLink
Date�—�9-8�% <br />Application For <br />PUBLIC WORKS PERlIIfIT <br />Print or Type Only <br />� <br />Describe Proposed Work <br />Prolect Address (it known) <br />PuEtic Works Pe�mit • <br />�v ti5 <br />BIOg.Oeo��• <br />Puouc Woeks Fea S'�, O, p O _ <br />Talal Fea <br />Lese Pppl Feo Peitl s�� <br />eeie��eo�a S <br />�0,00 <br />6 g6.zs <br />Zip Phone <br />- a licable� <br />Attach four (4) copies of plans for proposed work • Draw to scale and note � Ceo1'eW�ne of str et <br />• Property Lines • Indicale North <br />• Outline end dimensions of all existing and � Show any proposed grading changes <br />proposed slructures on the lot � Show measuremenls <br />� • Existlng and proposed utiiities <br />PERMIT CONDITIONS <br />1. All calls for inspection shall be made 24 hra in advance • phone 259-881 5. <br />2. All work shall 6e performed in accordance with this permit and current City o� Everelt Design and Construction <br />Standards and Specillcations. <br />3. Call Localion Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800•424-5555. <br />� / ' <br />I "�b � � ♦..-. •�iv.�l� <br />'�e.-t �Ottc1C u•,• ��u�c z <br />/ <br />,pr�+/7f r�� ��.�� . C.n��.—�i �<. w,�'�� lS �p C�Ja` <br />fJN ' G'.Q� �IC'N U� Ct' �rf'�+1�'_I <br />] <br />�. �NJp'4II I z�� `-�'�'c_ C+IVFC 7� /� C7'�Gh <br />fOt <br />FINAL INSPI <br />Approved ae <br />everett <br />e <br />�,��z,..�. <br />J� <br />Date <br />PUBI.IC WORKS DEPARTMENT <br />3200 Cedar Street <br />Everett, WA 98201 <br />Phone:259-8015 <br />Date <br />�/r.0 Ltw�Pr Ci/•�f��it� <br />W <br />� <br />� <br />� <br />� <br />O <br />� <br />� <br />O <br />a <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undersigned owner/aoplicant hereby agrees lo hold and save harm� <br />less the City ot Everelt trom any and all claims for damages, costs, <br />ezpenses, or causes of action thal may arise because ol installalion <br />and maintenance of the improvement or other right-of�way use hereto <br />applied for and further agrees to remove s 1he ubYn notice trom the <br />City andrjin r/epj7 laca public pr erty da g <br />a--�e�L� 1 / <br />/ <br />N <br />Signature of �PNI cant / Date <br />WORK AUTHORIZEU BY THIS PERMI �''�UST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISS ED AND THEREAFTER IS TO <br />BE �ILIGENTLV PURSUED TO COMPLETION. THIS FCRMIT MAY BE <br />ICPNCELLED BY THE C�TY UPON ANY STOPPAGE OP WORK ON THIS <br />P�jOJECT OVER 90 D:�YS UURATION. <br />� <br />z <br />0 <br />� <br />., <br />� <br />m <br />.-� .. <br />—I T <br />.-� --� <br />N 2 <br />m <br />co <br />m o <br />� c <br />o� <br />_ —�i <br />m <br />.o z <br />c <br />n� <br />r x <br />� �i <br />.� <br />T <br />O .� <br />�a <br />� m <br />x <br />m � <br />N <br />o r <br />�m <br />C N <br />N <br />'m <br />� � <br />m <br />n <br />A <br />� <br />2 <br />D <br />Z <br />� <br />� <br />� <br />Z <br />0 <br />� <br />� <br />m <br />