Laserfiche WebLink
Date ' - �`C � . <br />AppliCatiOn For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />Adtlress <br />Matling Atltlre55 <br />Describe Proposed Work <br />Projecl ACdress (il known) �C V/� — <br />c <br />CiIY �J ZiP <br />Attach lour (4) copies of plans for proposed work - Draw to scale and note the lollowing as applicable�. <br />� Property Lines <br />• Outline and dim�nsions of all existing and <br />proposed structures on the lot <br />• Ezisting and proposed utilities <br />Pu�l¢ Wo�ASPeimi ��_ /�`� <br />eiaq Den� � ._ �� <br />Pubbc Worke Fee s <br />To��l f ee <br />lesnApo� �ee PaiO $ <br />8alan<e Oax $ ZQ 00 <br />• Centedine al sireel <br />• Indiwte Nor�h <br />• Show any proposed grading changes <br />• Show measuremenl:; <br />Nnone <br />PERMITCONDITIONS <br />7. All calls for inspection shall be matle 24 hrs. in advance - phone 259-8810. <br />2. All work shall be pedormed in accordance with this permit and current Ciry o( Everett Design and Construction <br />Standards and Specifications. <br />3. Call Location Underground Service 48 hrs. betore you dig. TOLL FREE NUMBER 1•800•424•5555. <br />i 4.�1i �G/C�v.��.�[.n,Ui/2!/'�./ •ot'iS.r,�.2 .fOL��/)o�L(Gy� <br />.��.�e-T . �� � <br />!� <br />"/ � <br />!''� �2 �y y zt�/e e, <br />Approved lor Cons(t�ry c�"� n ... Date <br />/�/� � /•�—/'-�f� <br />FINAL 11VSPECTION Dale <br />Approved as Constructed <br />rvcrelt PUBLICWORKSO[PARTMENT <br />� 3200 Cedar Street <br />EvereU. WA 98201 <br />Phonc: 259-8810 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undersiqned owneUapplicant hereUy agrees to hold and save harm� <br />less the City ol Everett irom any and all claims lor damages. cosis, <br />expenses, or causes ol action that may arise because ol installatlon <br />and main�enance ol lhe improvemenl or olher right�ol-way use hereto <br />applied for and luriher agrees to remove same upon notice Irom ihe <br />ily and to replace public proper�y damaged thereby. <br />1 <br />��/ t-�)%� _����7�'_ -�. �� . �� .� � � � � � <br />Si9nature ol Applicant � Date <br />WORK AUTIIORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />180 DAVS OF DATE PERMIT IS ISSUED AND THEFEAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT �dAV BE <br />CANCELLED BY THF GTY UPON ANY STOPPAGE OF WORK OP! THIS <br />PROJECT OVER 90 DAYS DURATION. <br />