Laserfiche WebLink
Hn� <br />A�x <br />9HN <br />r <br />K n <br />� <br />�pJ N <br />�� <br />H <br />O�-y+d <br />H�g <br />Q Y (] <br />t"y� <br />NH <br />g� <br />�d� <br />� � L�1 <br />HOf�i� <br />, i_ �� <br />i �� <br />� <br />� <br />' �1_! <br />Date '� "��%lr <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />L� « <br />Mailing Address <br />Describe Proposed Work / �-��/ ( r ���/C` <br />Proiect Address lil known) <br />� <br />c��v z�P <br />r„ci�� wo�ws r�,m•in <br />-� .��7�` <br />n�aa ocoi � "� �1 � <br />v�m�c wo�xe vee $ <br />rniai vice <br />Le55RPpl prtePmit S <br />DAl��nfnnur S <br />Attach four (4) copies ol plans br proposed work • Draw lo scale and note 1he following as applicable: <br />• Property Lines • Cenlerline of ,treet <br />• Outline and dimensions of all ezisting and • Intlicate North <br />proposetl siructures on ihe lot • Show any proposed gratling chan9es <br />• Existing and proposed utilities • Show measurements <br />PERMIT CONDITIONS <br />1. All calls for inspection shall be made 24 hrs. in advance • phone 259•8810. <br />2. All work shall be pedormed in accordance wilh ihis permit and current City ol Everett Design and Consiruction <br />Slandards and Specifications. <br />3. Call Location Underground Service 4B hrs. belore you dig. TOLL FREE NUMBER 1-800•42�:•5555. <br />��(i -�l�r%N 1�'"'�/,.��.,..���;2.ii � <br />Construction <br />FINAL INSPECTION <br />qpproved as Constructed <br />evcrelt PUBLICWOPKSDEPARiMENT <br />� 3200 Cedar Street <br />Everett, WA 98201 <br />Phana 259�8810 <br />,�'. ��-� .t .,: �� <br />:I� � ./:,�/J-�^�:/%��.� <br />� � � �) �, <br />� -/ �/ <br />ACKNOWLEDGEMENT OF CONDITIONS <br />W <br />H <br />�w <br />_ / <br />Z <br />� <br />�w <br />—/ <br />O <br />a <br />The undersic�ned owner/applicaN hereby a9rees to hold and save harm� <br />less Ihe Cdy ol Everett Irom any antl all claims lor tlamages, costs. <br />expenses, or causes ol action thal may arise because of installallon <br />and maintenance ol the Improvement or olher right�obway use hereto <br />appliatl for and further ac�rees lo remove same upon notice Irom thc <br />U�te Cily and lo replace pubhc properry damac�ed �hereby. <br />SignaW re ot ApPlicanl uace <br />WORK AUTHORI2E0 BY THIS PERMIT MUST BE STARTED WITNIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTEF IS TO <br />BE DIIIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY 8[ <br />CANCELLED BV THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />��, <br />