Laserfiche WebLink
Date� 5 <br />Application For <br />PUBLI� WORKS PERMIT <br />Print or Type Only <br />Alailing Address <br />Applicant <br />Describe Proposed Work <br />Projecl Address(it known) <br />Ciry <br />.�� <br />Public 1Yorks Pcrmit • �j �� <br />oiaB. oeoi. • <br />Pubhc Wa�ks Fee <br />To�nl Fco $ _ <br />Less A00�� Fee Pald S /`/^ <br />BalanceDoe $ '�C!/�/�l� <br />/ iLJ 7"' <br />Zip Phone <br />Attach four (4) copies ot plans tor proposed work - Draw to scale and note the lollowing as applicable: <br />• Property Lines <br />• Outline and dimensions ol all existiny and <br />proposetl shuctures on ihe lot <br />• Exislin� and proposed utilities <br />PERMIT CONDITIONS <br />• Centerline ol street <br />• Indicate Norih <br />• Show any proposed grading changes <br />• Show measureinenis <br />1. All calls lor inspection shall be made 24 hrs. in a�vance - phone 259•88� b. <br />2. All work shall be perlormed in accordanca with this permit and current City ot Eveiett Design antl Consiruction <br />Standards and Specifications. <br />3. Call Location Undergrountl Service 48 hrs. belere you dig. TOLL FREE NUMBER 1•$00•424-5555. <br />'�Gi <br />•,�=/ /��, c��,� � /��' � <br />Approved lor Constru tion . Date <br />—/� � /, <br />yx/� �L,L�� 7 19 ��� <br />FINAL N�ECTION Date <br />4pproved as Consfructed <br />everett PUBLIC WORKS DEPARTMENT <br />� 3200 Cetlar S�reet <br />Everett, WA 98201 <br />Phone: 25�J-R875 <br />ACKNJWLEDGEMENT OF CONDITIONS <br />W <br />� <br />�w <br />_/ <br />1� <br />� <br />TP,a undersigned ovmer/applicanl hereUy agrees to hold and save hann� <br />less the City of Everet� Irom any and all claims for damages, costs, <br />expenses, or ceuses of action iha� may arise because ol installation <br />and maiMenance ol Ihe improvemeN cr other right�obway use hereto <br />applirtl for and luriher agrees to remove r.ame upon notice Irom the <br />Ciry and to re, lace public property damagel lhereby. <br />/ <br />C �_ —/�' <br />. .� In . !�_�FYJ.x�!'i.�-�•� <br />Sianature of Applicant Date <br />\NOHK AUTHORIZED BV 7Hi5 PERMIT MUST BE START[Cl WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED �ND TFIEHEAFTER IS TO <br />BE DILIGENTLY PURSUEO TO COMPLETION. THIS PERMIT MAY BE <br />CANC[LLED BY THE CITY UPON ANY STOPPAGG OF WOFK ON THIS <br />PRGJECT OVER 90 DAYS DURATION. <br />--i -~n <br />..� <br />�, _ <br />m <br />cv <br />m o <br />-i c <br />O 3 <br />�� <br />m <br />.O = <br />C <br />r 2 <br />—i N <br />1 <br />T <br />on <br />--f m <br />m � <br />� <br />o r <br />n m <br />� N <br />N <br />'m <br />z c-� <br />—� r <br />• m <br />n <br />z <br />� <br />x <br />n <br />z <br />-a <br />x <br />N <br />Z <br />O <br />�--1 <br />n <br />m <br />