Laserfiche WebLink
Date /f 5/,P'� <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />Owner <br />Applicant <br />Describe Proposed Work <br />Project Address (it known) 5���— <br />Address <br />PuLlic Worha Permn �^�7✓ <br />Pi[9 Deot. t_(F 6 � 1P� <br />PuElic WorMe Fee <br />TolalFee S,__ <br />Less Appl Fee Pnld S <br />Be�.ence D�e S �� <br />�- FuPr��F 9�Z0/ �J'r'c <br />Cily Lp <br />+��A 12A. �i �,�. = � <br />City Zip <br />71Y1 Q- —�(Y�,�7' /ri/t�6 (�!'PA <br />zi <br />Attach four (4) ccpies of p�ans lor proposed work • �raw to r,cale and note the folluwing as applicable: <br />� Property Lines <br />• Outline and dimensions of all existing and <br />proposed structures on Ihe lot <br />• Existing and proposed utilities <br />� Cenlerline of street <br />• Indicate North <br />• Sho�v any proposed grading �hanges <br />• Sliovi measurements <br />PF.RMIT CONDITIONS <br />1. All calls for inspection shall 6e made 24 hrs. in advance • phone 259•8$10. <br />2. All work shell be pedormed in acwrdance with this permit and wrren! Ciry of Everett Design and Construction <br />Stendards a�d Specifications. <br />3. Call Location U�derground Service 48 hrs. before you dig. TOLL FREE NUMBER 1•800-424•5555. <br />5! Rr t ocAr� Ll�e, �,rw.vy f�.� .PE„�u,.eFo P�.e e.n� <br />.STiD.�bN.�'t1S SECTiA.tI 3..3_/• <br />rNSrALC .V�i<l I.�iuEu//J� t�� (.'iTy STAtiC��� '�a 07, <br />.�io-v�._ 3 S< b'B <br />Approved lor Constr tio� ale <br />/� . .� -�i <br />FINAL INSPECTION Dale <br />Approved as Constructed <br />everett PUBLIC WORKS DEPARTMEN7 <br />� 3200CederStreet <br />Everett,'JJA 98201 <br />Phone: 259�8810 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />W <br />� <br />� <br />� <br />O <br />The undersignetl owner/applican� hereby agrees to hold anA save harm• <br />less the City ol Everett Irom any and all claims for damages. costs, <br />expenses, or causes ot adion that may arise because of installation <br />and maintenance of ihe improvement or o�her tighFol-way use hereto <br />applied lor and further agrees to remove same upon notice trom the <br />Cily and to replace puUlic property damaged thereby. <br />�� �� � NlZa/8� <br />Signature of Applicant � Date <br />WORK AUTHORIZED B THIS PERMIT MUST BE STARTEU WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUE� PND THEREAFTER IS TO <br />BE DILIGENTLI' PURSUED TO COMP�ETION. THIS PERMIT MAY BE <br />CANCELIED BY THE CITV UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />