Laserfiche WebLink
Oate 8 �q 8� <br />Appl�catlon For <br />PUBLIC VUORKS PERMIT <br />Print or Type Only <br />� <br />Describe Proposed W �k .,L.�� �3' r" ' <br />�/�� l ,Y��j— <br />i' <br />Projecl Addresa (if known) <br />_��� <br />PuO�ic WorA� Permil � ��� <br />9�ep. Deo�� � . — <br />P.ie�Icwo�kaFaa � <br />Tot�l Fee <br />�ess ApD� Fee P��C = <br />BN�nce Due s �� <br />� <br />„f j � 1. -:��^�' .7,s;� - ¢79'-.3 <br />i�y Zip Phone <br />.i�y Zip Phone <br />�� i�_�c'V � �/��r;��� <br />Adach four (4) copies of plans for proposed work • Draw to scale and note Ihe followir;. as applicable: <br />• Prope�ty Lines <br />• Outline end dimensions ot all existing end <br />propoeed structures on the lot <br />• Exisling and proposed utilities <br />• Canterline ot street <br />• Indicate Norih <br />� Show any proposed grading changes <br />• Show measurements <br />PERMIT CONDITIONS <br />1. All cells for inspection shell be made 24 hrs. in advance - phone 259•887 5. <br />2. All work ahall be peAormed in accordence with th!s permit and current City of Everett Design and Construction <br />Standarda and Specifications. <br />3. Call Locetion Underground Service 48 hrs. belore you dig. TOLL FREE NUMBER 7•800•424•5555. <br />f,' �,�,ar,,v<s Cu� ;.-�:,�,— �v s, r3:' t-� T:�.vE'v <br />�/,r/OF.A Ti/.F D.c'.r/E«Ifly: <br />— � �/!l' l�%a-�� �/ g6 <br />ApproveA tor Cor.struct on D te <br />� /O � 7 —�' G <br />L INSPECTI Date <br />Ap�raved as Constructed � <br />everett PUBLIC WORKS DEPAR7MENT <br />� 3200 Ceder Street <br />Everett, WA 98201 <br />Phone:259-0815 <br />����gai <br />� ; , °�'� <br />� <br />ACKNOWLEDGEMENT OF CONDITIONS <br />W <br />H <br />� <br />� <br />� <br />O <br />� <br />� <br />0 <br />a <br />The undeisigned owner/applicant hereby agrees to hold and seve harm- <br />less the Cily of Everett from nny and all claims for damages, costs, <br />expenses, or causes of action that mey arise because of instaltation <br />and mainFen3�C8'Q� �he improvement or other rigM•of-way use hereto <br />applie0 for and furJher agrees to remove same upon notice Irom the <br />Citv and to repla� public property darQHged thereby. <br />N'ORK AttT�BY THIS ERMIT 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 DUi7ATION. <br />