Laserfiche WebLink
:r <br />L <br />L <br />r <br />Date.�L�Ld:3 <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Typa Only <br />Applicant <br />Describe Froposed Work <br />Mailing <br />Address <br />Prolect tiddress (if knawn) .'� �� I l�i"1 fC PJ� <br />av3 <br />Zip <br />Attach four 1�) copies ol plans tor proposed work • Draw to scale and note ihe lollowing as applicable� <br />• Property Lines <br />• Outline and tlimensions of all ezisting and <br />proposed siruCWres on the lot <br />• Ezisting end proposed utilities <br />n„ei�c wm�s aerma • 3 L L <br />Biep. Dem. • 3 a U_ <br />v�eec wods Poa s�O , 0 c� <br />Tolnl Fea <br />le5e AOD� Fea PaiE S � <br />Balance Oue � �• � � <br />� y7.�.2. <br />• Centerline ol street <br />• Indicate North <br />• Show any proposed grading changes <br />• Show measuremenis <br />rnono <br />PERMIT CONDITIONS <br />1. All calls for inspection shall be made 24 h,�s. in advance � phone 259-8815. <br />2. AI� work shell be perlormed in accordance with this permit nntl current City ol Everett Design antl Construction <br />Standards and Specilications. <br />3. Call Location Underground Service 4B hrs. belore you dip. TOLL FREE NUMBER 1•S00•424-5555. <br />/. I.XtSY�nc `�ad�� o� �x��P� lS noY � bC �I �erPdl <br />a � <br />� 9-�r-s's <br />Appro�ved I�r C�ction Date <br />0 <br />�%•i! � � // <br />FINAL INSPECTIO Dale <br />Approved as Constructetl <br />evere[t PUBLIC WORKS DEPARTMENT <br />� 3200 Cedar Street <br />Everett WA 98201 <br />Phone:259-8015 <br />�CKNOWLEDGEMENT OF CONDITIONS <br />W <br />� <br />_/ <br />� <br />O <br />� <br />� <br />� <br />a <br />� <br />The undersigned owner/applic�nt hereby agrees to ho�d and save haim- <br />less ihe Ciry of Everett irom any and all claims for damages, costs, <br />eapenses, or causes o� action that may arise because ot installation <br />and maintenance ol the improvement or other right-ol-way use hereto <br />applied lor and lurther agrees to remove same upon notice lrom Ihe <br />City and to replace p blic pwperty damaged thereby. <br />� T, �`� <br />?j/�'i J L � --IS J <br />ignature of Appii��nt Date <br />WORK AUTHORI�tD BY THIS PERMIT MUST BE STARTED WITHIN <br />160 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS 10 <br />BE bILIGENTIY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BV THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJEC' OVER 90 DAYS DURATION. J <br />i <br />J <br />J <br />1 <br />