Laserfiche WebLink
� <br />Date -.Y.�.1 <br />Application For <br />PUBLIC WORKS PERMIT <br />� p��R <br />Print or Type Only �� �L�Mp � <br />3 �_._---- <br />)a����t ��;- <br />Address <br />CitY Zip <br />Publ¢ WorkS Permit e�� � � <br />Bltlg. Oept.• <br />Publ¢ Works Fee � � �:i <br />Totel Fee S <br />�ess AOP� Fee PaIC S <br />Balanca Oue <br />sdo�.� <br />.ad?_/7z, f, <br />City Lip rnuue <br />Describe Proposed Work ' a� �'�' e Il T� �3 �- T� � t C �� d7 rY � t T <br />�„ _' � l=. S 1- � l l�Y f- r. _ <br />Prolect Address (il known) � 3 b <br />Atlach lour (4) copies of plans for proposed work - Draw lo scale and note the lollowing as applica6le: <br />• Property Lines • Centerline ot street <br />• Outline and dimensions of all existing and • Indicate North <br />proposed structures on the lot • Show any proposed grading changes <br />• Existing and proposed utilities • Show measuremenis <br />PERMIT CONDITIONS <br />1. All calls lor inspection shall be made 24 hrs. in advance - phone 2S9•88� �J. <br />2. All work shall be perfonned in accordance with ihis permit and cwrent Ciry of Everett Design and Construclion <br />Standards and Specificatlons. <br />3. Call Loca�ion Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1•800•424•5555. <br />�. Ca ,� �.� w�l�. �.p-!, �a 39 - s�az Z' � I o �a.�le ,.� �.�1� <br />• 1 r�^ <br />sP.r'v i c e s�..,,y� _o•sc vo� V� . �•� <br />�,;w Pow e w�e�.�i- o.�'e � � k-- w.,,�s 3- <br />� f'a-cL � <br />" Approved as <br />everett <br />Le <br />S. �11 �a�'�.�C -� b.z <br />w,.�....�/,.�� oP <br />�Ns�al�e�5! �e �.e <br />�N�(7 GC�{ �� <br />N GP..-1e � (�A�-�J�. <br />PUBLIC WORKS DEP.4RTMENT <br />3200 Cedar Sireet <br />Everett. WA 98201 <br />Phone:259-8815 <br />u alv � � 7� ts <br />� �� ��'s-�-� � � <br />�NS�I�CcY W�^`\vi �-�G <br />a�� -r-L,;� . 9� �I;SI.,d- <br />5�-,-,�,o.. o�� � <br />�[LS 1.�$ <br />Date <br />fCo-�way <br />( <br />IQ/w i.,.�s�-i�e � <br />SWM1\t MI.I\�1fe� <br />P.�blti wo: �s <br />� ra i�..'RS e � <br />W <br />� <br />� <br />� <br />� <br />0 <br />� <br />� <br />O <br />a <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undersigned owner/applicant hereby agrees to hold and save harm• <br />less the City ol Everelt Irom any and all claims for damages, cosis, <br />expenses, or causes ol action ihat may arise because ot installation <br />and maintenance of the improvemertt or other right-of-way use hereto <br />applied for and lurther agrees to remove same upon notice from lhe <br />City and to replace public property damaged thereby. <br />q � ,- <br />i <br />- /-f�� �'i�� /����, �t���c-�-.— <br />Signature o� Applicant � Date <br />WORK AU HORIZED BY THIS PERMIT MUST BE STAFTED WITHIN <br />180 OAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />GA�JCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJtCT OVER 90 DAYS DURATION. <br />