Laserfiche WebLink
01 <br />Date %� Q�/ <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />City Zip <br />Public Works Permits O <br />Bldg. Dept.+ <br />------------- <br />Public Works Fee a �90 <br />Total Fee <br />Less Appt Fee Paid $ ^ _ <br />Balance Due $ M20--� <br />Phone <br />c <br />Applicant Mailing Address City Zip Phone <br />/ o <br />T PLC) i4o <br />Describe Proposed Work �-C4i•S (TZ6iC�°� M <br />m <br />Project Address (if known( <br />Attach four (4) copies of plans for proposed work - Draw to scale and note the following as applicable: <br />• Property Lines • Centerline of street <br />• Outline and dimensions of all existing and • Indicate North <br />proposed structures on the lot • Show any proposed grading changes <br />• Existing and proposed utilities • Slow measurements <br />PERMIT CONDITIONS <br />1, All calls for inspection shall be made 24 hrs, in advance - phone 259.881 5. <br />2. All work shall be performed in accordance with thi,, permit and current City of Everett Design and Construction <br />Standards and Specifications. <br />3. Call Location Underground Service 48 hrs. before you dig, TOLL FREE NUMBER 1.800-424.5555. <br />C'iry sT�a 3�-ST <br />6" <br />GJ/LC iJc'T r�� <br />z <br />O <br />/�wJ <br />I <br />O <br />fe [c ceJ.1p T� Ccirt)/✓L� T etT7VT/�' <br />�/l7J"J .C�//ilfJ �d✓T `z'�l'"- 'e_T_9PcK ACKNOWLEDGEMENT OF CONDITIONS <br />The undersigned owner/applicant hereby agrees to hold and save harm- <br />less the City of Everett from any and all claims for damages, costs, <br />expenses, or causes of action that may arise because of installation <br />and maintenance of the improvement or other right-ol-way use hereto <br />applied for and I!u thora9(ees to remove same upon notice from the <br />Date cm, wndsn remlaee'6obllc property damaged thereby. A <br />FINAL INSPECTION Ud" Datd <br />Approved as Constructed Signature of Applicant <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />everett PUBLIC WORKS D =PARTMENT 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />3200 Cedar Street BE DILIGENTLY PURSUED TO COMPLETION, THIS PERMIT MAY BE <br />Everett, WA 98201 CANCELLED BY rHE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />Phone: 259-8815 PROJECT OVER 90 DAYS DURATION. <br />N 2 <br />m <br />0o <br />m o <br />n <br />CD c <br />r <br />m <br />-1 z <br />x <br />m <br />�z <br />