Laserfiche WebLink
Date�6 / <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />Mailing Address <br />maumg qdaress <br />Describe Proposed Work <br />Project Address (ii known) � �"� <br />Attach four (4) copies of plans for proposed work • Drav <br />• Property Lines <br />• Outline and dimensions ot all existing and <br />proposed structures on the lot <br />• Exfsting and proposed utilities <br />City <br />Zip <br />Ui�y Lip <br />to scale and note ihe following as applicabfe: <br />r�m�<wo�Fsv��ma• G / —�7/ <br />oia9 0�, i. + <br />Pu�h¢ Wo�ks Fee S <br />Tatal Fev — <br />Less Ao01. Fee Pa�d S <br />aa�e�« o�a s .t/V C'f/9�PGE <br />• Centerline ot sireet <br />� Indicate North <br />� Show any nroposed grading changes <br />• Show measurements <br />PERMIT CONDITIONS <br />1. All ceils for inspection shall be made 24 hrs. in advance - phone 259•887 5. <br />2. All work sheli b� pertormed in accordance with this permit and current Ciry of Everett Design and Construction <br />Stendards and Specifications. <br />3. Call Locatfon Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1•800-424•5555. <br />T � /�E'/��G C�O.rJT/21�C �E'9 �j��PF� •'�'T /�%UKiCTFD <br />BL!/� .9Cf�SS �U�Piir/!r CO/t/ST.�c.�lT.'on.� %.Q.9�G <br />�j�'� i✓iT.ES . <br />(�o.rJs uc : TiS�E �'i� T.P<,'� c I�Ef?T_ o,c' <br />• J�-,��� /, J/jp + <br />�n� C� �L'C7 ?a_ .J �n J / <br />Approved for Cons ruction Date <br />FINA�. INSPECTION Date <br />Approved as Constructed <br />everett PUBLIC WORKS DEPARTMENT <br />� 3200 Cedar Street <br />Everelt. WA 98201 <br />Phone:259-8815 <br />,C7Er�,,� S� <br />ACKNOWLEDGEMENT OF CONDITIONS <br />W <br />� <br />� <br />� <br />� <br />O <br />a <br />The undersigned owner/applicar,t hereby agrees to hold and save harm• <br />less ihe City of Everell Irom any and a�l cleims for damages, costs, <br />expenses. or causes of action that may arise because ol installation <br />and maiMenance of tlie improvement or other right-o�-way use heretc <br />applied lor and further agrees to remove same upon nolice �rom �he <br />City and to replace public property damaged thereby. <br />Signature of Applicant Da�e <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMITIS ISSUED AND THEREAFTER IS TO <br />BE DI�IGENTIY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OYER 30 DAYS DURATION. <br />