Laserfiche WebLink
.:� i:: <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />�i�� � rC� T�� lC� <br />XOQre55 <br />Describe Proposed Work <br />Project Address (if known) <br />Pu01¢ WarMa Permil • � — /�� <br />Bldp. Oepl. + <br />PunLc \Yo�ks Fee <br />Total Feo S _ <br />Less AOD� Fee PaiE S.�_ <br />Balxnce�ue S—�Q� <br />Phone <br />Lip Phone <br />Attech lour (4) copies of plans tor proposed work - Draw to scale and note the following as applicable: <br />• Property Lines <br />• Outline and dimensions of all existing and <br />pioposed structures on the lot <br />• Existing and proposed utilities <br />• Centerline ol street <br />• Indicate N�rih <br />• Show any proposed grading changes <br />• Show mea5urenenis <br />PERMITCONDITIONS <br />1. All calls for inspection shall be made 24 hrs. in advance • phone 259•8810. <br />2. Ali work shall be peAormed in accordance with this permit and current City of Everett Design and Construction <br />Standards and Specificetlons. <br />3. Call �ocation Underground Service 48 hrs. hefore you dig. TOLL FREE NUMBER 1•800-424•5555. <br />� /?�'�L�C/�'�t/i /S To �'UNi/�G% 7�r1 %,'� � T,��/_'/J /N ,i�,�_ <br />l.CJ�9ir� 0.��'i" %�? � > J -a b'o (v �j'c 6,r,�,E,,C)ii✓v %i-/�' N�= _F.d <br />F.� y/�t/inr' 1J.✓ Ti;�� <<J�'TF,c S'c c//i<.�' �.� 7,�.s l_�JT. <br />, j ,9,oPCic�JnJT W/G L P.�'rJ✓i0� Eysc��Ni DOcur��i�iT <br />�.z Acc�.�s ,9�2oss �or �B <br />�� �� � gB <br />Approved for Construction Date <br />�� <br />i <br />�� -ol -. �� <br />'� FINAL SPECTION Date <br />Approved as Constructed <br />everett PUBLIC WORKS DEPARTMENT <br />� 3200 Cedar S;reel <br />Everetl, WA 98201 <br />Phone:259-8870 <br />ACKNOWLEDGEMENT OF COND�TIONS <br />W <br />H <br />� <br />I•1 <br />U <br />� <br />� <br />O <br />a <br />The undersigned ownedapplicant he�eby agrees to hold and save harnr <br />less Ihe City ol Everelt Irom any and all claims for damages, cosl; <br />eapenses. Or CauseS of action thal may arise beCauSe Of installation <br />and maintenance ol the improvement or other right�ol•way use heretc <br />applied lor and further agrees to remove same upon notice irom th= <br />City and to replace public property damaged thereby. <br />��I .�i����_L( i �/P �f, L[,!C � <br />Signet�re of Applicant Dat.� <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITNIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PEFMIT MAY BE <br />CANCELLED DY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />