Laserfiche WebLink
��� <br />H <br />�Hy <br />H�� <br />fC C� <br />H� <br />� � � <br />Hy <br />��lp <br />NC7 <br />��8 <br />�Y � <br />C"y� <br />HH <br />gy <br />H <br />n�� <br />�O� <br />1 <br />� <br />� <br />Date�L,�/_� 7 <br />"f I <br />•y <br />Applica0on For <br />PUBLIC WORKS P�F�MIT <br />Print or Type Only <br />Arfdress <br />rueLcwo�wePnm��t• � �� <br />uue oaot . � <br />PubhcWo�bFeo S, <br />Tolal Foe <br />Lesa Poo� Fee Pa�a S ^� <br />Batance Oue S � <br />� ^ � � - Phone <br />�'�qpplicant MaJing Address Cily Zip <br />Describe P�oposed Work <br />Project Address (il known) <br />2 t <br />f= «� <br />Att�ch four 14) copies ol plans lor proposed work • Draw to scale and note. CQo1,edine ot stree� able: <br />• Properry Lines • Inditate Nor�h <br />• Outline and dimensions ol all existinc� and � Show any proposed grading changes <br />proposed structures on the lot � Show measuremenls <br />• ExiSting and proposed utilitie5 <br />PERh11T CONDITICNS <br />1. All calls lor inspe �tion shall be made 2d hrs m advance • phone 259•881 5. <br />2. Ail work shall be perlormed in accordance with this permit and current Ciry ol Everett Design anA Construclion <br />Stantlards and Specilications. <br />3. Call Location Underground Service 48 hrs 6efore you dig. TOLL FREE NUMGER 1•800•424•5555. <br />� �mf'�- ...� $ l� 7 <br />qpprovedforCon ctio Date <br />- ' ��' 2" -y" / <br />FINAL INSPECTION Date <br />�ppmved as ConsiructeA <br />evr�e�t PUBLIC WORKS DEPARTMENT <br />� 3200 Cedar Slreet <br />Everett, WA 98201 <br />Phone:259-8815 <br />ACKNOWLEDGEMENT OF GONDITIONS <br />W <br />H <br />�w <br />_ / <br />� <br />O <br />� <br />� <br />0 <br />a <br />The undersigned owne.r/npplicant hereUy agrees w hold and save harm- <br />less Ihe Ci�y ol E�eretl Irom any and all claims lor damac�es. cosis. <br />eapenses, a causes ol action Ihat may arise because of installation <br />and maintenance ol the improvcment or other right�of-way use herelo <br />applied for and furiher a9rees to remove same upon nntice from ihe <br />Cdy and lo replace public proper�y damaged Ihereby. <br />� . . - /,—r�/% ( '' i - s / <br />ipnatU,.•61 f� pll ant/ �' oatc <br />WORK AUTHORIZED BY Tt11S PERMIT MUST BE STARTED WITHI'J <br />180 DAYS OF DAT[ PERMIT IS ISSUED AND THEREAFTER IS T�� <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BY THE GITY UPON ANY S10PPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />