Laserfiche WebLink
Date���i <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />Ma�i��,�� ndd�o55 <br />AppGcant Mailin9 Addresa <br />Describe PropoSE•d Wark <br />Pro�ert qdtlress n' known) <br />z�n <br />z�� <br />Attach four (4) [ o���ies ol plans �or proposed work - Draw to scale and note the lollcwing as apPlicable: <br />• Pre�[crty Lines <br />A G •!�ne and dimen;ions ol all existing and <br />prU� c:��etl StruClureS On �he lo� <br />• Exisd��,3 and proposed utilities <br />Pub�m 1'to�ks P�.rmil • (/ '_�/ ��� <br />aina oeoi . _���Oc-/ ��. � <br />Pu�Lc Yforlg fce <br />i01N Frte `S — <br />Lesslnpl FeePam $— <br />2�o,�.,�,:,, �,,,• s _ <br />• Centerline ol street <br />• Indicale North <br />• Show any proposed��rading changes <br />• ShOw m8d5Ur8RIef1I5 <br />PIlOOE <br />Phone <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 pertormed in accordance with this permit and current City ot F�erett Design and Construction <br />Standards and Specilications. <br />3. Call Location Underground Service 48 hrs. betore you dig. TOLL FREE NUMBER 1•800•424•5555. <br />Approved for o struction <br />FINAL TNSPECTION � - ' '-" ' <br />Approved as Constructed <br />everet[ PUBLIGWORKSDEPARTMENT <br />� 3200 Cedar Slreet <br />Everet6 WA 98201 <br />Phone:259�8810 <br />Date <br />ACKNOWL[DGEMENT OF CONDITIONS <br />W <br />H <br />� <br />� <br />� <br />O <br />The undersi9ned owner/applicanl hereby agrees to hold and save harm� <br />Iess the City of Everetl Irom any and all claims for damages. costs. <br />e■penses, or causes of action thal may arise because ol installation <br />and maintenance ot the improvement or other righl-ol•way use hereto <br />applied for and furlher agrces to remove same upon notice Irom the <br />City and lo replace public property damaged thereby. <br />��! �E) ��. X'�. �`r30— $y <br />Si nature ol ApUhcant Dat� <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PFRM1IIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />