Laserfiche WebLink
Date <br />Application For <br />PUBLIC `JVORKS PERMIT <br />Print or Type Only <br />Pu�bc\VorksPermn� 87-3B6' <br />BItlB� DepL � <br />Pu01ic Wods Fea S <br />iolal Feo <br />Lesc Ao��� Foe Paid S <br />BalancaDue S ��QO <br />� ,!1� <br />•�: r+L j?c:G�G/ri.o -1 %��/ y�Hl✓/?��'� ��' /L �i l <br />:�•��ir <br />AppliCant <br />Address <br />� <br /><<.�., y�r� ��, n <br />Mailing Address <br />City <br />.`� r (yJ , % { <br />��/�•�G <br />� <br />DescribeProposedWork ��+�I�L�7� Uvi Fvv Q ....,.,.,n i _ <br />Project Address (ii known) ✓ r�' � AJ- /✓�/ /J _ <br />Attach four (4) copies of plans for proposed work • Draw to scale and note the fol�xving as applicable: <br />• Property Lines •:entr rline ot street <br />• Outline and dirr,ansions of ail existing and � I,idicate North <br />proposed strucWres on the lot � Show any proposed grading changes <br />• Existing and proposed utilities • Show measurements <br />PERMIT CONDITIONS <br />1. All calls for inspection shall be made 24 hrs. in advance - phone 259•881 5. <br />2. All work shall be performed in accordance with Ihis permit and current City of Everett Design and Conslruction <br />Standards and Specifications <br />3. Call Location Undorground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800•424•5555. <br />y. ��:c,�,9.�r r co.�.,� ro s�w,E-,e . <br />S, /P�i�aov� CU.�B <br />� fJ�L.O XEPL�Cc4� /i/�Ti�/ <br />`�9 I�.z��.��„� C�/T, <br />c�'"�iir �o,�� /Z�/6 r <br />Approved lor Construc on ate <br />� a2Xa=C� /o. j/• �` � <br />INSPECTION � Date <br />Approved as Constructed <br />everett PUBLIC WORKS DEPARTMENT <br />� 3200 Cedar Street <br />Everett, WA 98207 <br />Phone:259�8815 <br />ACKNOWLEDGEMENT OF COUDITIONS <br />W <br />� <br />� <br />� <br />O <br />� <br />� <br />0 <br />a <br />The undersigned owner/applicant hereby agrees to hold and save harm- <br />less the City of Everett from any and all claims for damages, costs, <br />expenses, or causes of action that may arise because of installation <br />and maintenance of the improvement or olher righl-of-way use hereto <br />applied tor and luriher agrees to remove same upon notice trom the <br />City and to replace public properry damaged thereby. <br />// "Z j `d'� <br />Signature oi Applicant Date <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND TfiEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON TrIIS <br />PROJECT OVER 90 DA\'S DURATION. �— <br />