Laserfiche WebLink
Date <br />Appiication For <br />PUBLIC V!/ORKS PERMIT <br />Print or Type Only <br />cant <br />Mailing Address <br />AOOfBSS <br />Puoiic Woiks Parmit • <br />eiea. oen�� • _ <br />PuClic Wo�ks Fae <br />Totel Fee s <br />Lans A00� Fee P��U : <br />Ba�enca Dm i <br />2 �9 • 73 z�-ccu,� <br />/`�ZQ� 373-CJ�j <br />Zip Phone <br />uP Ynone <br />p f � /_ <br />Deccribe f'roposed Work ���i��Y��l�! �/�I� 1 � C, C� � � � (L � <br />Project Address (if k,.�wn) <br />Attach four (4) copias of plens for proposed work • Draw to scale end note the following es apVlicable: <br />• Property Linea <br />��utline end dimensions of all eziaHnq and <br />p�oposad atructures on the lot <br />• Exlsting and proDosad utilities <br />PERMIT CONDITIONS <br />• Centerline of streel <br />• Ind+cate North <br />• Show eny proposed grading changea <br />• Show meesurements <br />1. All calle for Innpectlon shall be made 24 hrs. in edvanca • phone 259•8815. <br />2. All work ahell be performed In accordance with this permit and current City of Everett Design and Constructlon <br />Stenderda end Specificat(ons <br />3. Call Location Underg�ound Service 48 hrs. before you dig. TOLL FREE NUMBER 1•800•424•5555. <br />�UBciL Ce�a.e,�t f�-:ehiiT ,tio� �'Fc,�v�,eF� <br />Approved br Construction pate <br />FINAL INSPECTION Date <br />Approved es Constructed <br />everett PUBLIC WORKS DEPARTMENT <br />� 3200 Cedar Street <br />Everett, WA 98201 <br />Phone: 259-8815 <br />(v.ZS B7 <br />y�f�'c� <br />ACKNOWIEDGEMENT OF CON[11TIONS <br />W <br />H <br />� <br />�I'; <br />� I <br />� I <br />I <br />I <br />Z <br />O <br />� <br />� <br />The undersigned owner/applicant hereby agrees to hold and save harm• i <br />less the City ol Everett irom any and all claims for damages, costs, � <br />expenses, or ceuses of action that may arise because of installation <br />and maintenance of the improvement or other right•of•way use hereto <br />app�ied lor and further agree� to remove same upon notice Irom the <br />City and to rep�ace public properry damaged thereby. <br />Signature of Applicant Date <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DII.IGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY @E <br />CANCELLED BY THE CITY UPUN ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />