Laserfiche WebLink
� � <br />H <br />�H� <br />H�H <br />!i C] <br />pH� <br />'i1 H � <br />Hy <br />'�o <br />OHd <br />��8 <br />ij] Y (7 <br />t" y 'Z <br />HH <br />gy <br />H <br />f]CU1 <br />C <br />Wr <br />t=i <br />HOfyi� <br />� . • ._ . � ` <br />�:l <br />Applicalion For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />Mailing <br />Mailing <br />1�M <br />ruouc lvoiks Porm(�n . / I/!� <br />Biee. Oept • —�T-�?(/�J-- <br />PUUL[ Worhf f eB <br />Totai Fce g <br />tess aooi. Fce Pma 5 <br />eaiance ouo s <br />ciry up rnone <br />DescribeProposedWork ���P_ 1C (��u�p�ci�/ /�.J//PG �/�D.�� <br />�- . <br />Project Address lif known� <br />Attach lour (4) copies ol plans �or proposed wo�k - �raw to scale and note ihe lollowing as applicable: <br />• Property Lines <br />• Outline and dimensions of all existing and <br />proposed sirucWres on the lot <br />• Ezisling and proposetl ulililies <br />• Centedine ol streel <br />• Indicate Norlh <br />• Show any proposed gradinc� changes <br />• Show measurements <br />PERMIT CONDITIONS <br />1. All Galls for inspection 5hall be m�de 24 hrs. in advante • phOne 2$9•8810. <br />2. All work shall be pertormed in accortlanco wilh ihis permit and current City ol Everett Design and Conslruction <br />Standards and Specifications. <br />3. Call Location Underground Service 4B hrs. belore you aiy. TOLL FREE NUMBER 1•800-424•5555. <br />� <br />/�<<lc« a�c,�� /�;::,..�f/1:J'���:����� <br />����r,��S,z<.-z:� ,t�,.-�. z'�,/,: >>�: �:,,�. <br />Approved lor Construction Date <br />FINAL INSPECTION <br />Approved as Constructed <br />�evcrett PUBUC WORKSDEPARTMENT <br />� 3200 Cedar Street <br />Everett, WA 98201 <br />Phonc:259�8�10 <br />Date <br />��f;��i� <br />/ - �4— �n <br />ACKNOWLEDGEM[NT OF CONDITIONS <br />W <br />H <br />_ / <br />� <br />� <br />`rA <br />V ♦ <br />O <br />a <br />The underslgned owneUapplicant hereby agrees to hold and save harm� <br />less the Cily ol Everett irom any and all claims for damages, costs. <br />expenses, or causes ol aclion that may arise because ol installalion <br />and maintenance ol ihe Improvement or other ri9ht�of-way use hereto <br />applied lor and lurther aprees to remove same upon notice irom ihe <br />City and to replace pubGc property damaged thereby. <br />SignaWre of Applicant Dale <br />WORK AUTHORIZED BY TNIS PERMIT MUST BE STARTED WITHIN <br />1B0 DAYS OF DATE PERMIT IS ISSUED AND THEFiEAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERI,�IT MAY BC- <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />